RIT Intercollegiate Athletics & Recreation| Wellness

Special Events Requests - External Form

Rochester Institute of Technology
Center for Intercollegiate Athletics and Recreation
113 Lomb Memorial Drive
Rochester, NY 14623-5608
Ph: 585-475-6082 Fax: 585-475-5378

Please note - if this event is a non-athletic "community" event, and/or may require other campus support services, or use of other campus facilities, do not complete this form -- contact the RIT Office of Govt. & Community Relations at 585-475-5012.

[* required field]

*Event Title (Activity):

A value is required.

*Name of Applicant:

A value is required. Invalid format.

*Organization/Group:

A value is required.

*Phone #:

(H) A value is required. Invalid format ((xxx) xxx-xxxx).
(W) A value is required. Invalid format ((xxx) xxx-xxxx).
(C) A value is required. Invalid format ((xxx) xxx-xxxx).

*E-Mail:

A value is required. Invalid format.

Fax #:

A value is required. Invalid format ((xxx) xxx-xxxx).

Address:

City:

State: Zip:

Specific Day(s)/Date(s) of Activity (if you are trying to establish a date, please indicate time frame desired, eg. weekdays / weekends / week / month / time of day, etc)

	Day and* Date	Setup should start at:	Event should start at (or open doors at):	Event should end at:	Tear down ends by:
*1:
2:
3:

Detailed Description of Event:

Objective/Purpose of Event:

Type of Activity:

Meeting Lecture Conference Game
Sports Practice Exhibit Concert
Tournament, Type Of:
Other, Please Specify:

Type of Space needed:

Student Life Center:
(Where appropriate, indicate number needed)

Classroom(s): Courts:
Locker Rooms:
Other:
Clark Gym (has bleachers) Aux. Gym
Clark Gym Stage Grass Field(s):
Turf Field

Critical Information

Is this event open to the public? (comments if necessary)

Yes No

Numbers expected:

Participants:
Spectators:

Are you charging a fee?

Yes No

Participant fee: $
Spectator fee: $

Age range of participants:

Is this event a fundraiser?

Yes No If Yes, for Whom?

Food Service

Will food be served/sold?

Yes No If Yes, by Whom?
NOTE: Food must be pre-packaged or delivered by a licensed vendor.

Special Equipment Requests

PA System Shot Clock Bleachers Lined Field Track/Field Equip. Tables (#): Chairs (#):
Other Sports Equip:
A/V Equip: (indicate type)

Support Staff

Note: Indicate number of staff needed where appropriate.

Ticket Taker(s): Scoreboard Operator Shot Clock Operator
Announcer Security: Custodial:
Other:

Parking Needs

Number of cars expected: Buses:
Handicapped spaces: Equip. Parking:

Where has this event been held in the past?

References: (Please provide a personal reference or contact person where event has been held in the past.)

1:	Name:
	Title:
	Phone:	A value is required. Invalid format ((xxx) xxx-xxxx).

NOTE: At the time of agreement, a certificate of insurance must be furnished by applicant indicating general liability coverage with minimum limits of $1,000,000 naming RIT as an additional insured. Certificate must be received by the Center, no less than ten (10) days prior to rental date.

One or more mandatory pieces of information has been left blank or some of the information is in an invalid format. Please review the form and provide all mandatory information and then submit.