Customer Details First Name: * Last Name: * Your Email: * Your Phone Number: * Company Name: ABN: Address: Billing Address: (if different) Video Conference Details Date of Conference: *---12345678910111213141516171819202122232425262728293031 ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---201820192020 Room Hire Time: * 123456789101112:000510152025303540455055 AMPM Time Zone: *---NZST - ends 30 Sep 2018NZDT - 30 Sep 2018 to 7 Apr 2019AEST (QLD, NSW, VIC, TAS, ACT) - ends 7 Oct 2018ACST (NT, SA) - ends 7 Oct 2018AWST (WA)AEDT (NSW, VIC, TAS, ACT) - 7 Oct 2018 to 7 Apr 2019AEST (QLD) - 7 Oct 2018 to 7 Apr 2019ACST (NT) - 7 Oct 2018 to 7 Apr 2019ACDT (SA) - 7 Oct 2018 to 7 Apr 2019 Conference Duration: * 0123456789101112 Hours and 00153045 Minutes Room Locations Location 1 Preferred Location: * Attendee Name: * Attendee Number: * Please Note: Point to Point IP connection is included with video room hire. If you will be connecting with more than one location or via ISDN, please provide those details in the additional information box below. Far Site Location Connection Type---IP dial inIP dial outISDN dial in IP/ISDN # Contact Name Contact Phone Contact Email Presenting Materials? (ppt etc.):---YesNo RecordingRequired?---YesNo Additional Information: * I accept Chorus Call's Terms & Conditions and confirm that information above is accurate.