Qualtrics Survey | Qualtrics Experience Management

Contact information for the person requesting:

First and last name

Email

Phone

Name of requesting group or organization:

Name of the event (if applicable):

What date(s) is the event scheduled for?

Date(s)

Location of event:

Name of venue (if applicable)

Street Address

City

State

Zip Code

Type of event (check all that apply):

Public
Private
Free
Paid

Number of attendees expected at event:

Event start time:

Event end time:

Is there an outdoor space that's level, paved, within 100 feet of electricity, and has room for a truck and trailer that take up 50 feet when parked? All of these specifications are required.

Yes
No

With the right space and electricity requirements, it usually takes us 30 min to set up. What time should we arrive?

Due to our requirements for space and electricity, will we need to bring the WOW in days before? If so, when? Please be specific.

Due to our requirements for space and electricity, will we need to pick up the WOW at a different time? If so, when? Please be specific.

If we need to leave the WOW overnight, will the event space be secure and safe from theft and vandalism?

Yes
No

In the event of inclement weather, will your event continue?

Yes
No, but it will be rescheduled
No, and it won't be rescheduled

If the event is rescheduled, what's the date?

Will anything be provided by the event organizers, such as tables, chairs, tents, etc.? If so, please be specific and state the items provided.

I understand that the WOW is a vehicle that has no water, heating, air conditioning and cannot be used in the rain.

Yes, I acknowledge the above statement.

Please attach an image of where you think the WOW can be parked for your event. Keep in mind the space and electrical requirements as stated in the previous question. If your event doesn't have an event map, please use Google Map's satellite image from the web to create an image and indicate possible parking, along with arrows to indicate how it can get in and out. The side door of the WOW is on the passenger side.

Payment information part 1:

Name of requesting person and organization

Mailing address

Telephone number

Fax number if available

Federal ID Number (FEIN)

Email address

Payment information part 2:

Complete Form W-9 from the IRS https://www.irs.gov/pub/irs-pdf/fw9.pdf and upload:

I understand that my school or organization will not be billed until AFTER the event.

Yes, I acknowledge the statement above.

Do we have permission to take photographs and or video of your staff and participants during our visit and while they are interacting with our staff and the WOW? The photos may be used for educational and promotional purposes of the University of Memphis, and will not be produced for profit. No person will be identified. If there is anyone who doesn't want to be photographed or videoed, we will abide by their requests.

Yes
No

Is there anything else we need to know, such as another contact, etc.?