Murray Dodge RESERVATION REQUEST

Organization Name     Account number

Contact Name    E-mail   Phone/Cell

Event Title      Number of People Expected

Day/Date of Event    List multiple dates in space provided below

Event begins (include set up time)  am/pm.     Event ends (include clean up time) am/pm.

Location of Event

Event Description 

List other groups involved with this event 

How is this event being funded?(Please explain and give anticipated costs). If you need additional space, email Joanne Sismondo.

Yes No   Has this event location been approved? 

Name, E-mail and phone of person approving space

To Do Checklist:  Individual submitting this form is responsible for contacting requested and/or
required department services listed below: 

Yes No    Security:  Stanhope, Don Reichling, 8-3132 
Yes
No   Safeguards Student Agencies:  Clio, 2nd FL, 8-2255
Yes
No  Building Services Equipment Rental: 180 Alexander St., 8-3490
Yes No   Building Services clean up: 180 Alexander St., Mark Bahadurian, 8-5989
Yes   No  Food/Dining Services: 106 Alexander St., 8-6098

Yes   No Please give contact info for outside Caterer
Yes   No OIT/Media Services: 8-4603
Yes   No  Insurance Required: 2 New South, Karen Bauer, 8-3046
Yes   No   Electricians: MacMillan Bldg., Ken Grayson, 8-3991
Yes   No   Carpenters: MacMillan Bldg., Paul DiDonato, 8-3432
Yes   No   Grounds/Maintenance: MacMillan Bldg., Jim Consolloy,  8-3505
Yes   No   Conference Services: For any outdoor space, 71 University Pl., 8-6115
Yes   No   Security deposit for Murray-Dodge Hall keys ($20 cash deposit): Joanne Sismondo, 8-5460

List all multiple event dates below:

September:  

October:       

November:   

December:    

January:        

February:     

March:          

April:            

May:            

June:           

July:            

August:      

    

Current Officer Information: 

President:      E-mail:    Phone/Cell:   

Treasurer:      E-mail:    Phone/Cell:   

Approved by:  ____________________________________________________   Dated:  ___________