Title of Event: 

Building Requested: 

Room Requested: 

Event Date:  Sunday Monday Tuesday Wednesday Thursday Friday Saturday   &  January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2008 2009 2010 2011 2012

Is this event open to the outside public? Yes No

Est. Attendance: 

Do you want this event listed in This Week at Lycoming?Yes No

Beginning of Event:   am pm  End of Event:         am pm
Beginning of set-up: am pm  End of tear down: am pm

Requestor:         Campus Box #:

Phone #: 

Sponsoring Organization or Department: 

Please list any equipment needed in the following section:


Special Instructions:

Notices to keep in mind:

• Requests should be submitted seven (7) working days prior to an event, but requests should be submitted as early as possible to ensure the availability of facilities.
• Facilities are scheduled on a first come, first serve basis.
• Reserving one area does not give access to any adjoining areas without permission.
• It is the requestor's responsibility to confirm any B&G, Security, and Food Service requirements.
• Requestor is also responsible for keeping the facility clean and returning it to its original requirements.
• NO TAPE may be used on any painted surfaces.
• Requestor will be held responsible for any damages to the facilities.
• Smoking is permitted only in designated areas.