Online Brookdale Facility Reservation Form

CONTACT INFORMATION

Name*

First Last

Organization Name*

Primary Phone Number*

Secondary Phone Number

Fax

Email*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Do you have an account code?

Yes
No

If you do have an account code, please enter it in the box below.

EVENT INFORMATION

Presenter Name*

First Last

Presentation Title*

Estimated Attendance*

What is the room name and number that you would like to reserve? (e.g., MAN 105)*

NOTE: Specific rooms may be requests. However, rooms will be determined by the Scheduling Office based upon availability, type of event, and the applicant's logistical requirements. You must call Scheduling first to schedule your room. This form should not be submitted without this information.

Type of event*

Event Dates*

Date	Start Time	End Time

Enter your event date(s) here. Click the plus sign to add more rows.

Event Details/Room Set Up*

Please describe your event set up the with as many details as possible in the box above.

Equipment/Personnel Requested

Police/Safety/Security
Custodial
Catering
Other

Check all that apply

Technology Requested

Check all that apply

Additional Notes

Please provide any additional notes or requests in the box above.

PLEASE NOTE

A certificate of insurance is required for all events

The applicant must obtain insurance coverage with an acceptable carrier, with personal liability of at least one million ($1,000,000) dollars and one hundred thousand ($100,000) dollars in property damage and provide a certificate of such insurance to the College before using the college facilities.

Submission of this form does not guarantee a room reservation

TERMS AND AGREEMENT

I show by this agreement that I understand that I am not to advertise or in any way promote or publicize this program until I have received written approval from Brookdale Community College. I declare that I am an authorized agent of a responsible organization, and as such, make application to Brookdale Community College for the use of college facilities. I warrant that the applicant organization and members will observe all regulations of the College, and will pay promptly any agreed fees, and that the applicant will exercise the utmost care in the use of school premises and will make full restitution for any damage arising from the applicant's use of said premises. If the applicant organization is a Brookdale department or organization, I understand that my account will be debited automatically.

By clicking "Submit", I indicate that I agree to the terms and conditions of this application.