Facilities Use Form This form should be turned in no less than two (2) weeks before the scheduled event. Submission of this form does not constitute a reservationand does not guarantee service or staffing availability. Availability of rooms, equipment and staffing will be determined by Business Services and IMS. Event Title: Event Date: Space should be setup by: -- 1 2 3 4 5 6 7 8 9 10 11 12 -- 00 15 30 45 AM PM Event Start Time: -- 1 2 3 4 5 6 7 8 9 10 11 12 -- 00 15 30 45 AM PM Event End Time: -- 1 2 3 4 5 6 7 8 9 10 11 12 -- 00 15 30 45 AM PM Event End Date (if applicable): Publish on Web Calendar: Yes No Host Department/Organization: Event Location/Building: Ad Building Centennial Plaza Fine Arts Center Franz Center Goering Hall Goerz House The Green Haury Hall James A. Will Family Academic Center Kauffman Museum KIPCOR Krehbiel Science Center Mantz Library Memorial Grove Mem Hall Schultz Student Center Thresher Gym Thresher Stadium Voth Hall Room or Space: Attendees Expected: Contact Person: Phone: E-mail: Admission Fee or Suggested Donation: Yes No Audio Reinforcement (PA): Single mic on stand/podium Powered speaker Additional sound requests (elaborate below) Video Projection Computer DVD Blu-ray Disc (BD) Document Camera Video recording (additional fee) Digital file (AVC) DVD format: Copies: Audio recording (additional fee) Digital file (MP3) Copies: CD format: Request Live Streaming Please contact BC AV <bcav@bethelks.edu> to confirm the time and location Other tech requests (elaborate below) Support Equipment: Folding tables Number: , Size: Folding chairs Number: Extension cords Number: , Length: Display Easels Number: Piano (FAC, Mem. Hall, and SSC only) Kitchen Access (FAC only) Staffing requests Events staff IMS staff Custodial staff Lighting requests Mem Hall stage lights KA stage lights general wash Set lights beyond stage wash (coordinate with AV staff) Request for access to catwalks to set lights Thermal temperature stand Thermal temperature stand I acknowledge the machine will be monitored 15 minutes prior to and 15 minutes past the event start time. Bethel College Business Services and Information & Media Services reserve the right to modify your request according to availability and/or appropriateness. Some fees may apply based on space, services or equipment associated with the event. Signature By signing below, I agree to abide by all Bethel College and campus regulations regarding the use of space and I agree to restore the space to an orderly condition for the next user. I also recognize that this is a request for space and equipment, not a confirmation and that I should not advertise this event until I have received a confirmation from Bethel College Business Services. I also agree to make a concerted effort to lock or in another manner secure the rooms and or buildings utilized in my event. If I am unable to lock the spaces, I will contact Bethel personnel to help with the securing of the spaces. Department or Organization Representative: PLEASE NOTE SPECIAL SETUPS or submit additional sheets to Business Services ← Back