Event/Facility Registration Form
Student Activities/Union: 371-7913

Application must be completed, returned and approved by appropriate departments in order to confirm reservation.  Please send your request as least two weeks prior to your event. Phone reservations are tentative only and are not confirmed without form.  Some reservations may require additional forms, including Certificate of Insurance, Fee Contract, catering, alcohol registration, etc.

Confirmation # :                 Date of Request :
                            (FOR OFFICE USE ONLY)

RESERVATION INFORMATION:

Name/Type of Event  
Day and Date of Event  01 / 01 /2004

Organization/Dept.   Phone #
Contact Person   Phone #
Advisor   Phone #

Any additional tech requests for events must be handled through the Student Union immediately upon completing this request.  This is a separate form and can be obtained by contacting 396-8027
Note: Single numbers must be entered in areas where "0" appears. If that field is not required, leave it as it is.

Setup begins: Event begins: 
Event ends: Breakdown ends:

   # Expected to attend:             Catered event        Alcohol served  

Admission Charge   If yes, $                            Theatre Approval  

Note ***  All catered events must be contracted through Chartwells International, Inc.  Reserving party must contact Chartwells at 396-8008.

FACILITIES TO BE USED

  Facility
1.
2.
3.
4.
5.

For Table, Chair reservations, or Set Up arrangements go to Campus Operations MOP

Items Required : 
Podium     Microphone  

    Risers/Staging-size required (ex: 6ftX6ft)

Special Request (additional power, set-ups, sound and light, etc.) must be arranged through the Buildings and Grounds department by the reserving party by calling 365-7551.

Any overtime required will be charged by Buildings and Grounds to an account number provided by the reserving party.  Given sufficient notice, Buildings and Grounds will provide a not-to-exceed estimate of charges.  No overtime for events will be authorized, scheduled or performed without a chargeable account number #

Program Description: 

Wellness Model Component (Select One)

Spiritual Physical Intellectual Career    
Emotional Social Community Service Fundraiser Meeting

                       

I have read all event guidelines and understand the responsibilities placed on the Sponsoring Organization(s). If any event is to be cancelled it must be done no later than ONE WEEK prior to the date of that event. If the event is not cancelled ONE WEEK prior, the club/organization will be charged a $50 non-refundable cancellation fee.

PUBLIC SAFETY

Public Safety Officers:         Fairfield Police:        Fire:    

Special Parking:                  Other:

*Applicant's name:    * E-Mail :

Please include any additional request that you may need below.

Check the box that best describes the sponsoring group: (Must Select One)
Club or Organization
Department or Faculty/Staff
Outside Vendors


* = Required