<table>
<colgroup>
<col style="width: 30%" />
<col style="width: 11%" />
<col style="width: 8%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 10%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 26%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="11">Date</td>
</tr>
<tr class="even">
<td colspan="11">Meeting Name:</td>
</tr>
<tr class="odd">
<td colspan="4">Principal Contact:</td>
<td colspan="7">Title:</td>
</tr>
<tr class="even">
<td colspan="11">Division Office:</td>
</tr>
<tr class="odd">
<td>Phone:</td>
<td colspan="5">Fax:_____________________</td>
<td colspan="5">E-mail:_________________________</td>
</tr>
<tr class="even">
<td colspan="11">Proposed Date(s) of Event:</td>
</tr>
<tr class="odd">
<td colspan="11">Site (known or preferred):</td>
</tr>
<tr class="even">
<td>Number of Attendees:</td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td>Sponsored:</td>
<td colspan="2">Speakers:</td>
<td colspan="7">Self-Paying:</td>
<td>Total:</td>
</tr>
<tr class="even">
<td> Travel</td>
<td colspan="4"> Travel</td>
<td colspan="5">Staff</td>
<td></td>
</tr>
<tr class="odd">
<td><p> Local Travel</p>
<p>mileage/parking</p></td>
<td colspan="4"><p> Local travel</p>
<p>mileage/parking</p></td>
<td colspan="5">Other</td>
<td></td>
</tr>
<tr class="even">
<td> Hotel</td>
<td colspan="4"> Hotel</td>
<td colspan="5"></td>
<td></td>
</tr>
<tr class="odd">
<td> Per Diem</td>
<td colspan="4"> Per Diem</td>
<td colspan="4"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td> Other:</td>
<td colspan="8"> Honorarium (Amount):$</td>
<td colspan="2">No. of days:</td>
</tr>
<tr class="odd">
<td colspan="11"></td>
</tr>
<tr class="even">
<td colspan="11">Description of Function or Activity:</td>
</tr>
<tr class="odd">
<td colspan="11"></td>
</tr>
<tr class="even">
<td colspan="11"></td>
</tr>
<tr class="odd">
<td><strong>Requested Services:</strong></td>
<td colspan="9"></td>
<td></td>
</tr>
<tr class="even">
<td><strong>I. Planning</strong></td>
<td colspan="9"></td>
<td></td>
</tr>
<tr class="odd">
<td> Site Recommendations</td>
<td colspan="9"> Recommendations for Theme &amp; Format and Format</td>
<td> Speaker Recruitment</td>
</tr>
<tr class="even">
<td> Site Inspection</td>
<td colspan="9"> Draft Agenda</td>
<td> Speaker Coordination</td>
</tr>
<tr class="odd">
<td colspan="11"></td>
</tr>
<tr class="even">
<td colspan="11"><strong>II. Event Promotion and Participant
Communications</strong></td>
</tr>
<tr class="odd">
<td colspan="11"> Participant Mailing List - Who will provide to
contractor?</td>
</tr>
<tr class="even">
<td colspan="2"> Develop Participant Database</td>
<td colspan="9"> Produce/Distribute Registration and Travel
Materials</td>
</tr>
<tr class="odd">
<td colspan="2"> Produce/Distribute Invitation Letters</td>
<td colspan="9"> Participant Packets will include:</td>
</tr>
<tr class="even">
<td colspan="11"> Produce/Distribute Confirmation Letters</td>
</tr>
<tr class="odd">
<td colspan="11"><p> Record Registration Fee</p>
<p>-Is the Contractor responsible to collect the registration fee? Yes
No</p>
<p>-How will registration forms be received? fax, e-mail, Internet
on-site?</p></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="9"></td>
</tr>
<tr class="odd">
<td colspan="2"><p><strong>III. Travel Arrangements</strong></p>
<p> Provide Pre-Paid Tickets to Sponsored</p>
<p>Participants</p></td>
<td colspan="9"><p> Provide Assistance in Preparing Travel
Authorization</p>
<p>Form and Travel Roster (when tickets are provided by</p>
<p>a Government Travel Agent)</p></td>
</tr>
<tr class="even">
<td></td>
<td colspan="6"></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="7"><strong>IV. Meeting Space &amp; Sleeping
Rooms</strong></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td> Sleeping Room Block</td>
<td colspan="7">No. Rooms____________________</td>
<td colspan="3">No. Nights__________________</td>
</tr>
<tr class="odd">
<td>General Session Room</td>
<td colspan="7"> AM PM No. Seats________</td>
<td colspan="3">No. Days____________________</td>
</tr>
<tr class="even">
<td></td>
<td colspan="7"></td>
<td colspan="3">Room Set-Up________________</td>
</tr>
<tr class="odd">
<td> Break-Out Rooms</td>
<td colspan="7"> AM PM No. Seats________</td>
<td colspan="3">No. Days____________________</td>
</tr>
<tr class="even">
<td> Exhibit Area</td>
<td colspan="7"></td>
<td colspan="3">Room Set-Up________________</td>
</tr>
<tr class="odd">
<td colspan="11"> Other <em>(specify)</em></td>
</tr>
<tr class="even">
<td colspan="11"></td>
</tr>
</tbody>
</table>

<table>
<colgroup>
<col style="width: 30%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 24%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 4%" />
<col style="width: 14%" />
<col style="width: 14%" />
</colgroup>
<tbody>
<tr class="odd">
<td><strong>V. Meeting Materials</strong></td>
<td colspan="3"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td> Name Badges</td>
<td colspan="3"> 3-Ring Binders</td>
<td colspan="6"> Thematic Signage</td>
</tr>
<tr class="odd">
<td> Name Tents</td>
<td colspan="3"> Double-Pocket Folders</td>
<td colspan="6"> Directional Signage</td>
</tr>
<tr class="even">
<td> Writing Pads</td>
<td colspan="4"> Pens</td>
<td colspan="5"> Pencils</td>
</tr>
<tr class="odd">
<td colspan="10"> Promotional/Commemorative Items – who will
provide?</td>
</tr>
<tr class="even">
<td colspan="10"> Other <em>(specify)</em></td>
</tr>
<tr class="odd">
<td colspan="10"></td>
</tr>
<tr class="even">
<td colspan="10"><strong>VI. Reproduction/Printing
Services</strong></td>
</tr>
<tr class="odd">
<td colspan="3"> Participant List No. _____________</td>
<td colspan="7"> Hand-Outs No.________________</td>
</tr>
<tr class="even">
<td colspan="3"> Speakers List No.</td>
<td colspan="7"> Logos required on meeting materials</td>
</tr>
<tr class="odd">
<td colspan="3"> Agenda No. _____________</td>
<td colspan="7"> Minutes/Final Report No.________________</td>
</tr>
<tr class="even">
<td colspan="3"> Evaluation Form No. ____________</td>
<td colspan="7"> Other (specify)__________________________________</td>
</tr>
<tr class="odd">
<td colspan="10"></td>
</tr>
<tr class="even">
<td colspan="10"><strong>VII. On-Site Services</strong></td>
</tr>
<tr class="odd">
<td> Manage Registration Area</td>
<td colspan="3"> Provide Message Center</td>
<td colspan="6"> Provide/Manage Display Area</td>
</tr>
<tr class="even">
<td><p> Provide Recorder(s)</p>
<p> Provide Summary</p>
<p>Writer/Note Taker</p></td>
<td colspan="3"><p> Provide Telephone</p>
<p> Business Center Account</p></td>
<td colspan="6"><p> Provide Projectionist/Equipment</p>
<p>Operator</p></td>
</tr>
<tr class="odd">
<td colspan="10"> Verbatim Transcription of Proceedings</td>
</tr>
<tr class="even">
<td colspan="10"></td>
</tr>
<tr class="odd">
<td colspan="10"><strong>VIII. Audio Visual
Services/Equipment</strong></td>
</tr>
<tr class="even">
<td colspan="2"> Overhead Projector/Screen</td>
<td colspan="5"> Tape Recorder</td>
<td colspan="3"> Slide Projector/Screen</td>
</tr>
<tr class="odd">
<td colspan="2"> VCR and Monitor</td>
<td colspan="5"> Microphone(s) No._________</td>
<td colspan="3"> Flip Chart/Markers No.____</td>
</tr>
<tr class="even">
<td colspan="2"> Computer/Printer</td>
<td colspan="5"> Lectern/Podium</td>
<td colspan="3"> Presentation Pointers</td>
</tr>
<tr class="odd">
<td colspan="10"> Video Taping Type:</td>
</tr>
<tr class="even">
<td colspan="10"> Other <em>(specify)</em></td>
</tr>
<tr class="odd">
<td colspan="10"></td>
</tr>
<tr class="even">
<td colspan="10"><strong>IX. Publications/Services</strong></td>
</tr>
<tr class="odd">
<td colspan="2"> Word Processing</td>
<td colspan="7"> Presentation Graphics</td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"> Technical Writing/Editing</td>
<td colspan="6"> Proceedings Report Production</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2"> Speaker Bios</td>
<td colspan="6"> Journals (describe)</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2"> Press Packages</td>
<td colspan="6"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="10"></td>
</tr>
<tr class="even">
<td colspan="10"><strong>X: Other Meeting Needs</strong></td>
</tr>
<tr class="odd">
<td colspan="2"> Porter/Messenger</td>
<td colspan="2"> Deaf Interpreter</td>
<td colspan="6"> Blank Vu Graphs</td>
</tr>
<tr class="even">
<td colspan="2"> Photographer</td>
<td colspan="2"> Security</td>
<td colspan="6"> Boxes</td>
</tr>
<tr class="odd">
<td colspan="2"> Timer</td>
<td colspan="8"> Other (specify)</td>
</tr>
<tr class="even">
<td colspan="10"></td>
</tr>
<tr class="odd">
<td colspan="10"><strong>XI. Analytical Support and Consulting
Services</strong></td>
</tr>
<tr class="even">
<td colspan="2"> Training Needs Assessment</td>
<td colspan="2"> Evaluation Services</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td colspan="2"> Literature Search and Analysis</td>
<td colspan="2"> Data Collection/ Analysis</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="2"> Survey</td>
<td colspan="2"> Special Study</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td colspan="10"> Other (specify)</td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>XII. Post Meeting Services</strong></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="2"> Participant Reimbursements</td>
<td colspan="4"> Report Distribution</td>
<td colspan="4"> Payment of Hotel/Vendors</td>
</tr>
<tr class="odd">
<td colspan="2"> Thank You Letters</td>
<td colspan="4"> Database Maintenance</td>
<td colspan="4"> Financial Report</td>
</tr>
<tr class="even">
<td colspan="10"> Summary Report of Proceedings</td>
</tr>
<tr class="odd">
<td colspan="10"> Other (specify)</td>
</tr>
<tr class="even">
<td colspan="10"></td>
</tr>
</tbody>
</table>

Special Instructions:

Requester Signature:

Title: Date:

**Bureau Finance Officer Authorization to Incur Costs *(must be signed
before sending to BETAH*)**

Signature

Date:

Special Instructions:
[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}