Iowa Communications Network
Request for Confidential Session
Fax Form

Fax completed form to the ICN Network Service Center at (515) 323-4414.
This session is CONFIDENTIAL. I request that it not be viewed or monitoried in any way, for any reason.

As the requester, I will notify participants that they should contact the ICN Classroom Operations Center at (515) 242-3182 to report any technical problems. (When using the fiber phone, dial 242-3182.)

 

Reservation #: ___________________________________



Date: ____________________________________________



Day of Week: _____________________________________



Start Time: ______________________________________



End Time: ________________________________________



Originate Site: __________________________________





Name of Requester: _______________________________



Phone: ___________________________________________



Agency: __________________________________________
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