Event Information
Event Title *
Event Description *
Please list a second room option if your first choice is not available.
Day(s) and Date(s) Requested *
Actual Event Start Time (Please Specify AM/PM) *
Actual Event End Time (Please Specify AM/PM) *
Estimated Attendance * Events with an estimated attendance of 100 or more will be required to provide a certificate
of insurance. A UTC staff member will contact you with more information upon receiving
your request.
If your answer to the previous question was Co-Sponsored, Speaker or Lecture, or Other,
please provide additional information. (Name of speaker, topic of event, co-sponsoring
organization, etc.)
Requested University Services
If microphone(s) are needed, please indicate how many and what type. (Number, wireless
or wired, lapel, etc)
If you only need a Media Tech to staff a portion of your event, please provide the
following time(s) here.
Additional Information
Please provide any additional information or special requests for your event below.
Facilities Use Terms and Conditions - Safety and Risk Management Statement
Facilities Use Terms and Conditions - Equal Opportunity Statement
Facilities Use Terms and Conditions - Electronic Signature
I have read and understand this agreement, and I am aware of the Facilities Use Terms
and Conditions above. I acknowledge that all listed information is accurate, and I
will let the appropriate department know if anything changes before this event. I
understand that failure to meet any conditions of this agreement shall result in a
cancellation at any time. I understand that this form is an application, and this
event should not be promoted until confirmation is received. I will also be responsible
for any billing services incurred. By electronically signing below, I am signifying
that I have read and understand this agreement. *
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