ࡱ> GIFi bjbj 4&HfHf 00uuuuu,egggggg$F!fuuuuuee]i^uQ0},! v!!uL!0 ;:  Facilities Usage Request/Agreement General Information: Date: __________________________ Organization: _________________________________ Activity: ____________________________________ Space/Room(s) Requested: ______________________________ Activity Date(s): ______________________ Start Time: __________________End Time: __________________ Time Room is to be ready: ___________ Projected Attendance: __________________________ Will group charge a fee? _______________________ Organization Representative: __________________________________ Telephone: ____________________ Address: __________________________________________________________________________________ Maintenance Set-up Instructions/Security Request: Will janitorial services be needed outside of regular working hours? __________________________________ If yes, Hours ____________ to _______________ Janitor scheduled: ________________________Will food be served? If yes, please explain: ______________ __________________________________________________________________________________________ Will security services be needed? ____________ If yes, please explain: _______________________________ __________________________________________________________________________________________ Indicate A/V equipment needed: Overhead projector Flip chart (reimbursement required for paper) TV/VCR Podium Chalkboard or Dry Erase Board Other, please specify: __________________________ The Applicant Organization/sponsor is responsible for enforcing Erskine policies while utilizing campus facilities. Individuals and/organizations who fail to enforce these policies may be denied the privilege to use Erskine facilities in the future. Additionally, any and all users shall indemnify, defend, and hold harmless Erskine, its officers, trustees, officers, directors, agents, and employees from and against any and all claims, damages, expenses, including an amount equal to reasonable attorneys fees, or liabilities arising out of or damage to any property, or of death or injury to any person or persons. Contact the Facilities Management Department for a detail of Erskines policies. As the Organization Representative, I certify that I am a duly authorized signer of the above-named organization, that I have received a copy of Erskines Facilities Usage Policies and Procedures, and that I have read, understood, and agree to follow (as well as those in attendance agree to follow) such policies and procedures for using the space/room(s) requested. ____________________________________________ ____________________________________________ Organization Representative Date Erskine Representative Date Approval: (For Erskine Use Only) College Official: ____________ Category: A B C D (circle one) Date Approved: _____________ Assessed Usage Fee: _________ Deposit: $__________________ (if required) Date Billed: ________________ Date Paid: __________________ Maint. Con.: _______________ A/V Con.: __________________ Insurance Cert. Requested: _____________________ Insurance Cert. 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