Event Request Form

Event Request Form

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Event Name*
Number of Attendees*
Intended Audience of Event*
Event Description*
Please check the current campus hours when scheduling your event. We do charge after-hours charges for events scheduled outside of campus hours.
Event Date*

MonthDayYear
Date
Two Week Check-in Date

MonthDayYear
Date
Setup Time*

Hour Minutes

AM/PM Option
Start Time*

Hour Minutes

AM/PM Option
End Time*

Hour Minutes

AM/PM Option
Time you will be finished using the space*

Hour Minutes

AM/PM Option
Multiple Days for The Event*

My event has another dayMy event is the same time but on multiple datesMy event is only on a single date
What are the additional dates for your event (you can enter dates up to one semester in advance)?*

Additional Information
Please enter any additional information on dates and times for your event.

Contact Information
CCC Department or Outside Organization*

CCC Department or DivisionAn Outside Organization or Individual
Is your Organization...*

For-ProfitNon-Profit - Education, Government, or 501(c)(3) status
Name*

First NameLast Name
Company/Organization Name*
Department - Please enter the Department you report to*
CCC Division*
Have you reviewed this with your direct supervisor?

YesNo
Before submitting, please review this event with your supervisor.
Phone Number*

Area CodePhone Number
Phone Extension
Best Phone Number to use for Day of Event Questions*

Area CodePhone Number
Email*
example@example.com

Outside Applicant Terms
Outside applicants terms, conditions and signature
Use of Coconino Community College facilities is governed by the Use of Facilities Policy and Procedure.

Applicant agrees to hold CCC harmless and will indemnify CCC for damages sustained as a result of injury or property damage for which CCC may be held responsible, as part of this request for use of CCC property.

Applicant assumes all responsibility for any food and beverages they choose to offer as part of this facility use event, and for any food-related damages, illness, or injury sustained by anyone in connection with this event.

The College reserves the right to cancel any reservation if deemed to be in its best interest to do so. The College will not be responsible for financial loss to a potential user if such cancellation is communicated five (5) calendar days before the scheduled facility use date. The College will not be responsible for financial loss to a potential user if the facility is made unavailable because of acts of God or any other circumstances beyond its control.

By signing this document, I agree to abide by the rules stated above as well as Coconino Community College Policies and Procedures. I understand this agreement may not be transferable to any other individual or group.

Please do not advertise your event until you receive final approval. While we do our best to accommodate all event requests, we are not able to approve every event request submitted.
Signature*

Clear
Date*

MonthDayYear
Date

Submit Area

	Number	Chairs at Each
Round Tables
Rectangular Tables
Tables for Food (rectangular)
Registration/Check-In Tables
Exhibitor Tables

Event Request Form

Contact Information

Facility and Room Information

Facilities Setup Request

Technology Requests

Food and Beverages

Parking Needs

Liability Insurance

Public Relations and Marketing

Outside applicants terms, conditions and signature

Internal applicants terms, conditions and signature