Special Event Request - External Form

RIT - Center for Recreation and Intramurals
Phone: 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):	*E-Mail:

*Name of Applicant:	Fax #:

*Organization/Group:	*Address of Organization:

*Phone: [ HOME ] [ WORK ] [ CELL ]	City: State: *Zip:

Specific Day(s)/Date(s) of Activity

If you are trying to establish a date, please indicate time frame desired (weekdays, weekends, week, month, time of day, etc.).

Day and Date	Setup starts at	Event starts at (doors open at)	Event ends at	Tear down ends by

Detailed Description of Event:

Objective/Purpose of Event:

Type of Activity:

Meeting	Lecture	Conference	Game
Exhibit	Concert	Sports Practice
Tournament, Type of:

Other, (specify type of event)

Type of Space needed:
Student Life Center (where appropriate, indicate number needed):
SLC court(s):	Mini Gym:	Dance Studio(s)	Classroom(s)

Locker Rooms	Other:

Clark Gymnasium:
Clark Gym (has bleachers)	Aux. Gym	Clark Gym Stage	Other
Fields:
Turf Field	Grass Field(s):	Other

Critical Information
Is this event open to the public?
Yes	No	Comments:
Numbers expected:

Participants:

Spectators:

Are you charging a fee?

Yes No

Age range of participants:

Food Service

Will food be served/sold?
Yes	No	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 Equipment
Tables (#)		Chairs (#)
Other Sports Equipment
Audio/Video Equipment (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		Equipment 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.)
	Name: Title: Phone:

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.