Registration Form for Temporary Network Access

Return form to the ITS HelpDesk or to your Event Coordinator.
Please print clearly and fill out the form completely.
Incomplete forms can not be processed.
Today’s Date: _____/______/_____

Section A
Required:
First Name:________________________  Last Name:_____________________________
Email Address: ___________________ Phone Number:______________________

Section B

1) Organization Name/Event:   ___________________________________________

2) Dates Requesting Access   ___________________________________________

Section C (Circle One)

1) Laptop             2) PDA             3) Other   _________________________

Operating System: (Please check all that apply)

_____Windows 95, 98, Me, NT, 2000, XP (circle version[s])

_____Macintosh OS Version________ (Please fill in version)

_____Unix/Linux __________________(Please specify type)

_____Other:

_____Antivirus Software:    Yes    or    No

           If Yes, please specify: _________________

Network Interface Card Information:

MAC (Adapter) address: ______:______:______:______:______:______

Without this MAC address you will not be able to get on the network. Be sure not to provide the PPP adapter address, which begins with 44. Instructions to help you find your MAC address can be found at: http://www.cbu.edu/ietc/network/findmac.html. If you have problems contact the helpdesk at 321-4438 and they can assist you.