Application for Use of College Facilities
Facility Requested:
Organization: Contact Person:
Address: City: State: Zip Code:
Telephone: Fax: E-mail:
Date and Time Requested:
Purpose of Use:
Estimated number of people attending the event:
Wireless handheld
Audio Visual assistance needed:
Yes No
Dates and times needed:
Visuals:
Projector ScreenComputer White Marker BoardVideo Projector
Piano:
Audio:
Yes No
Location:
Built-in podium Hardwired floorstands Wireless lavaliere
Housekeeping needed:
Yes No
Dates and times needed:
Signature: ____________________________________________ Date: ________________
Deposits are non-refundable and do not apply to the balance of your contract.
All rentals are cancelled if College closes due to inclement weather.
All College facilities are “smoke free.”
The user must provide adequate liability insurance. Gaston College is not responsible for personal injuries or property damages sustained
by individuals while on the premises in connection with the rental of facilities.
Users must remove all items or properties brought into the facility within 24 hours of the close of the event.
The college prohibits possession and use of alcoholic beverages on campus.
Payment of all charges is due ten days prior to rental.
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Dallas Campus
Myers Center Multipurpose Auditorium:
Cafeteria:
# of tables # chairs per table arranged
Kimbrell Campus
arranged# of tables # chairs per table
arranged# chairs per table# of tables
Kimbrell Classroom Auditorium:
The undersigned certifies that he/she has read and agrees to the regulations governing the facility usage as stated on the accompanying pages. The
undersigned further certifies that he/she is the authorized representative to act for and accept responsibility for the use of the facility. The undersigned must
also comply with campus security directives and requests.
For office use only:
Rent: _______________________
AV: _______________________
Housekeeping: _______________________
Security: _______________________
Contract Fee: _______________________
Balance Due: _______________________
Payment Information:
Name (As it appears on card): __________________________________________
Credit Card #: ____________________________ Expires: ________________
Signature: ___________________________________ Date: ___________________
Rental Guidelines
DALLAS CAMPUS
201 Hwy 321 South
Dallas, NC 28034
704-922-6406
Jennifer Phillips
Phillips.Jennifer@gaston.edu
KIMBRELL CAMPUS
PO Box 1044
Belmont, NC 28012
704-825-6256
Sandy Hamilton
Hamilton.Sandy@gaston.edu
