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ALL INFORMATION ON THIS FORM IS REQUIRED This (Miami Dade College)

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This form should be submitted immediately to the office of Campus Administration by fax or email. The organization
sponsoring the event is financially responsible for all program expenses and overtime. This form is for room reservations
only.
ALL INFORMATION ON THIS FORM IS REQUIRED
Date Submitted:
Contact Name:
Phone:
Fax:
E-mail:
Depart. Room Number/Campus: North
Name of department/company/organization hosting event:
Title/Name of Ev
ent:
Description of Room Setup Required:
A
pproximate Number of People attending:
MDC employees attending event?
Yes
Community members attending event?
Yes
MDC students attending event?
Yes
Serving Refreshments and/or food?
Yes
M-DCPS employees attending event?
Yes
Will there be an admission fee?
Yes
M-DCPS students attending event?
Yes
Admission Charge (if any):
External Community/Corporate
Leaders Attending Event?
Yes
No
Please Attach Attendee List to this Form.
Space(s) being requested: (Rooms with a * have a minimum capacity of 100.Check our website for capacity)
Science Complex:
A104*
Science Plaza
Tiki Hut
Building 4000:
MJ Taylor
4207-1
Quiet Dining Room
4000 Atrium
Building 3000:
3249- Hall A
3249- Hall B
3249- Hall C
3249- Hall D
3201
3202
3238
3239
3000 Atrium
Building 2000:
2151
2000 Atrium
7000 Atrium
Theaters:
Lehman Theater*
Studio Theater
5000 Atrium
5000 Lakeside
Other (please list)
Event Date(s):
Event Starting time:
Event Finishing Time:
Setup Starting Date:
(A standard 1 day prior to event is required for s
etup)
IF APPLICABLE (theaters only):
Rehearsal Date(s): Starting time: Finishing Time:
Technical Rehearsal Date(s): Starting time: Finishing Time:
Dress Rehearsal Date(s): Starting time: Finishing Time:
PLEASE LEAVE THE FAC
ILITY IN THE SAME CONDITION YOU FOUND IT IN. REMOVAL OF CHAIRS AND
RE-ARRANGING OF FURNITURE IS NOT PERMITTED WITHOUT A WORK ORDER.
YOUR RESERVATION IS NOT CONFIRMED UNTIL YOU RECEIVE AN APPROVAL RECEIPT
TO BE FILLED OUT BY ADMINISTRATIVE SERVICES OFFICE ONLY:
Rooms checked for availability (sign): ____________________________
Approved: Yes No _______________________________
Fermin Vazquez, Senior Director
INTERNAL USER: You are responsible for sending work request to AV/Media Services, Campus Services (setup/custodial), Public
Safety and Chartwells (2) weeks prior, and notifying them of cancellations
UNDER NO CIRCUMSTANCES IS FOOD AND DRINKS ALLOWED INSIDE OF THE LEHMAN THEATER, GREEN ROOM AND
A104. ANYONE IN VIOLATION OF THIS RULE WILL BE FINED A CLEANING FEE FOR ANY SPILLS.
Media Services personnel required? Yes No
Yes
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ALL INFORMATION ON THIS FORM IS REQUIRED This (Miami Dade College)

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Completed 7 November 2020

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