Fillable FORM Reviewed: October 2019 October 2019 (Nicolet Area Technical College)

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FORM Reviewed: October 2019 October 2019 (Nicolet Area Technical College)

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FORM
Contact Information (Required)
First Name:
Last Name:
Email:
Work Phone Number:
Organization Information (Required)
Organization Name: Job Title:
Address: City: State/Zip
Billing Address: (if different than above):
Insurance Provider: (Please provide a Certificate of Insurance before day of event)
Type of Organization: (Non-Profit, Government, For-Profit, Other)
Event Information (Required)
Name of Event:
Start Date:
End Date:
If more than one day- list all dates:
Start Time:
End Time:
Time of Set-up:
Time of Clean-up:
Estimated Attendance:
Facility Requested
check box
Hourly Rate Capacity Amenities
Classroom
☐
varies
Laptop, Monitor, Audio, Document Camera
Computer Lab
☐
varies
Laptop, Monitor, Audio, Desktop Computers
Fireside Room
☐
30-40
Laptop, Monitor, Audio, Fireplace, Kitchenette
Northwoods Center
☐
90
Laptop, Monitors, Audio
Theatre
☐
258
Projector, Screen, Audio, Microphone
Lakeside Commons
☐
200
Audio, Tables, Chairs
Lake Julia Terrace
☐
51
Tables, Chairs
Standard Service Rates
Nicolet on-site technology support - $75.00 an hour
Cancellation fee (15% of reservation charge when less than 72 hours notification)
SIGNATURE (person responsible for event outlined above):
(Name & Date)
Signature confirms the user has read, understands, and agrees to the terms, rates and conditions outlined in AP 6.01.
Title: Facility Use Request Form –
Number:
Adopted:
FR 6.01-a
January 2017
Reviewed: October 2019
Revised:
October 2019
This form is to reserve facilities on campus. Use of Nicolet facilities is subject to the terms and conditions
on this form and Administrative Policy 6.01 Facility Use. Nicolet College makes available its land, facilities
and equipment to community groups, public agencies, other educational institutions, or the private sector
at such times as they are not needed for College purposes. The facility use form must be completed and
emailed to Anne Wiedmaier, Executive Assistant. Email address:
events@nicoletcollege.edu
Telephone number
: 715.365.4415
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FORM Reviewed: October 2019 October 2019 (Nicolet Area Technical College)

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Completed 9 October 2020

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