Application to Schedule Facilities

Room Request Form

(Any field marked with an * is required)

1. Person Requesting

* Name
* Address
* E-mail
* Phone (day)
* Mail Location

2. Event Information

* Name of Event

* Sponsoring Department or Organization

* Specific Purpose of Event

* Expected Attendees

3. Choose a Room
Preferred Room Space
* Number Attending
* Dates (mm/dd/yyyy)
* Event Start Time
* Event End Time
* Start Time for Setup
* Food Served	Yes No

4. Event Open To * (Select one)
	Members Only
	All University
	Member & Guest
	Student & Faculty
	General Public #
# Only educational and cultural events may be opened to general public

5. Financial Arrangements
	Yes	No	Amount
* Admission
* Registration
* Donations
* Items for Sale

6. Speaker Information
* On Campus Speaker Yes No
* Off Campus Speaker Yes No
Name & Title
Affiliation
Title of speech

* Preferred Publishing Calendar (Select one or more)

7. Person Responsible
* Name * Phone (day) Address
* E-mail	Position in Organization Mail Location
* Affiliation: Academic Health Center UC East Non-COM UC West Other
* Status: Student Faculty/Staff Non University

8. Billing Arrangements (if applicable)

Send Bill To
UC Sponsored Organizations Must Supply CUFS number

I/ We acknowledge that the rules and regulations governing the usage of College of Medicine facilities. I/We acknowledge that my/our organization in the absence of posting a bond, will be financially responsible (1)for any damage caused by my/our use of Kresge Auditorium or College classroom; and (2) for any charges assessed by the College for services provided in connection with the above event.

I/We also acknowledge that the COLLEGE OF MEDICINE RESERVES THE RIGHT TO APPROVE OR DISAPPROVE WITHOUT JUSTIFICATION THE USE OF ANY COLLEGE FACILITY. It is further acknowledged that the College of Medicine reserves the right to cancel the Agreement FOR USE OF KRESGE AUDITORIUM AND CLASSROOMS any time prior to the date of the scheduled event and that the undersigned and his/her/their organization will hold harmless the College of Medicine, the University of Cincinnati, and any of their employees for taking such action.

I/We acknowledge that I/we received a copy of the SPECIFIC RULES AND REGULATIONS FOR THE USE OF KRESGE AUDITORIUM.

I/We acknowledge and agree to adhere to the rules and regulations which govern the College of Medicine Facilities.

Food / Beverage Policy
No food or beverages are permitted in classrooms or Kresge Auditorium

Comments

Yes I understand

(If this box is not checked, we will not be able to process your request).

For assistance or comments, contact Rose Bruns or Cade Stevens,at (513) 558-4186 or E-MAIL

INFO & SERVICES:

Room Request Form