Out-of-District Facility Reservation Request Form
Campus
Room Number
Equipment Needs






Will Money be Collected?

501C3#
Describe table/chair arrangements:

 

Minimum $1,000,000 Liability Coverage Required

Insurance Carrier
Policy Number
Amount of Coverage
Area
Dates of Reservation
List Other Equipment Needs
Purpose of Event
Start Time
End Time
Contact Person
Organization
Phone Number
Email:
Confirm Email:
Mailing Address