BOCES VC Services Virtual Field Trip (Point-to-Point) Reservation Form

If you would like any assistance, please phone: 1 888 427-9173 or E-mail: video@gw.neric.org

Your Contact Information

Your Name:

Phone:

Building and Room # where videoconference will occur:

School District:

E-Mail:

Optional: Your IP address or ISDN #s, if you know them:

Program Information

All Times Are U.S. Eastern Time - Daylight Savings When Applicable

Program Date:		Program Start Time:
Program Title:		Program End Time:

Content Provider Information

Please Verify With Your Content Provider That Conference Times Are
All Eastern U.S. Time - Daylight Savings When Applicable

If you are not using a content provider but instead are connecting to another classroom, enter the other classroom's information as the content provider.

Select Your Content Provider from This List:
Or, if it is not in the pull-down list,
Enter Your Content Provider in This Text Box:

Provider
Contact's
Name:

Provider Contact's
Phone:

Provider
Contact's
E-Mail:

Optional:

Any additional information your content provider may have given you, such as connection test dates, IP or ISDN #s:

Technical
Contact
Name:

Technical Contact's
Phone:

Technical
Contact's
E-Mail:

In a typical Virtual Field Trip we dial out to the content provider. If the content provider has agreed to dial, check here:

Questions or Special Notes
Regarding This Conference:

Submitting this form indicates that: . You have determined all costs(if any) associated with this videoconference, that you have confirmed that these costs (if any) have been approved and that you are authorized to submit this request. . You have confirmed room and equipment availability at each location. After you submit your form, a confirmation page will appear which may be printed for your records. You should also receive an E-mail confirmation within two working days.