University Center Application for Use of Facilities

Responsible Contact Information

Contact Name: *

Contact Email: *

Contact Phone Number: *

Contact Fax Number:

Sponsoring Organization, Department or Group: *

Responsible University Account:

Street Address/City/State/Zip if not associated with UTC:

Event Information

Event Title *

Please provide a description of your event. *

If you have requested the Chattanooga Room, which sections are you requesting? (Chattanooga A, Chattanooga BC, etc.)

Day(s) and Date(s) Requested: *

Actual Event Start Time (Please Specify AM/PM): *

Actual Event End Time (Please specify AM/PM): *

Do you want to reserve time to set up before your event?

Do you want to reserve time after your event?

What is your estimated attendance? *

Guests will include:

UTC Campus Community

General Public

Specific Invited Public Guests

Who is your target audience?

UTC Campus Community Members

Non-UTC Campus Community Members

Will your event bring anyone under the age of 18 years old on campus?

Yes

Will money be exchanged for this event?

Yes- Admission Will Be Charged

Yes- Onsite Merchandise Sales

If admission will be charged:

Money will be collected at the door

Tickets will be pre-sold with no sales at the door

If your answer to the previous question was co-sponsored, speaker/lecture, or other, please provide additional information. (Name of speaker, topic of event, co-sponsoring organization, etc.)

Requested University Services

Food and/or beverages served?

Yes (Please see next question)

If food/beverages will be served, what type of food service?

Refreshments

Boxed Lunch

Plated Meal

Buffet

Groups must contact UTC Dining at 423-425-4200 for all food and beverage needs.

I understand

Audio/visual needs requested?

Yes (Please see next question)

If audio/visual needs requested, what technology is needed?

Computer, Screen, & Projector

Microphone (Please see next question)

If microphones are needed, please indicate how many and what type. (Number, wireless or wired, lapel, etc.)

For Tennessee and Chattanooga Room requests, what type of set up does your event require?

Auditorium

Banquet

Classroom

FairExpo

Empty Room

Other

Groups must contact the UC Office at 423-425-4455 regarding specific set-up details at least one week prior to the event.

I understand

Additional Information

Please provide any special requests or additional information below.

Facilities Use Terms and Conditions - Safety and Risk Management Statement

In consideration for the permission of the University of Tennessee at Chattanooga to allow use of premises, the undersigned agrees to assume all responsibility and legal liability arising out and in the use of the aforementioned property. The undersigned further agrees to indemnify, save and hold harmless, the University of Tennessee at Chattanooga and its employees from any liability arising out of the use of this property. Further, the undersigned agrees to abide by all rules, standards or reasonable requests made by the University of Tennessee at Chattanooga relating to the use of these facilities and to adhere to all safety/fire code/minors on campus requirements as set forth by the University and to instruct participants to adhere to the same. Depending on the type of liability exposure, I understand that I may be asked to provide proof of current liability insurance and a certificate of insurance evidencing the University of Tennessee at Chattanooga as listed additional insured.

I understand and accept the safety and risk management statement.

Facilities Use Terms and Conditions - Equal Opportunity Statement

The University of Tennessee at Chattanooga is an equal employment/opportunity/affirmative action/Title VI/Title IX/Section 504/ADA/ADEA institution.

I understand and accept the 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 aggreement shall result in a cancellation at any time. I undersand 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. *

University Center

University Center Application for Use of Facilities

Prior to completing this form, please visit the link below for room descriptions and pictures to ensure your requested room will meet your meeting needs. Recurring meetings can be listed on the same request. Please include all dates and times.

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