*Today's Date:
*Sponsoring Organization (represents who is legally responsible for this proposed event):
      
*Primary Contact Person (legally responsible for event, ex. Faculty Advisor):
      
Student Representative:
      
*Mailing Address:

Street:
City:   State:   Zip:

*Brief description of the activity or event you are planning:

*Check each facility area(s) requested (see Student Recreation Center Facility page for area descriptions and costs). Additionally, view a diagram of the Student Recreation Center facility.

Activity/Event Request #1
Day/Date:

Time(s) desired, including when:
*Set up begins (please specify am/pm):
*Activity/event begins (please specify am/PM):
*Activity/event ends (please specify am/PM):
*Take down ends (please specify am/PM):

Activity/Event Request #2 (only complete if requesting more than one date)
Day/Date:

Time(s) desired, including when:
*Set up begins (please specify am/PM):
*Activity/event begins (please specify am/PM):
*Activity/event ends (please specify am/PM):
*Take down ends (please specify am/PM):

Activity/Event Request #3 (only complete if requesting more than two dates)
Day/Date:

Time(s) desired, including when:
*Set up begins (please specify am/PM):
*Activity/event begins (please specify am/PM):
*Activity/event ends (please specify am/PM):
*Take down ends (please specify am/PM):

Activity/Event Request #4 (only complete if requesting more than three dates)
Day/Date:

Time(s) desired, including when:
*Set up begins (please specify am/PM):
*Activity/event begins (please specify am/PM):
*Activity/event ends (please specify am/PM):
*Take down ends (please specify am/PM):

Activity/Event Request #5 (only complete if requesting more than four dates)
Day/Date:

Time(s) desired, including when:
*Set up begins (please specify am/PM):
*Activity/event begins (please specify am/PM):
*Activity/event ends (please specify am/PM):
*Take down ends (please specify am/PM):

*Anticipated number of participants (do not include spectators):
List age range of participants (if a youth group):
*Anticipated number of coaches/instructors/chaperones:
*Anticipated number of spectators:

*Check each Special Facility Need:

*Is the group providing athletic trainer or medical personnel? yes no

Please review the Student Recreation Center Food/Drink Vendor & Merchandise Policies.

*Is food/drink being provided, served or sold? Please explain:

All vendors must be contracted through the "requesting" organization.  A vendor fee of $100/day applies.

Name of Vendor #1:
Contact Person:
Dates for Vendor: to
Merchandise to be sold:

Name of Vendor #2:
Contact Person:
Dates for Vendor: to
Merchandise to be sold:

Name of Vendor #3:
Contact Person:
Dates for Vendor: to
Merchandise to be sold:

Any additional information? Please provide special set up needs, additional date explanations or any other pertinent information.

After you submit your request, do not forget to print out the "Form Submitted" page, which should appear after you submit your request. This will serve as a confirmation that your form was submitted. If you have any questions, contact Dave Hollinger (Facility Requests) or Micha Seither (Aquatics & Youth and Family).