Club & Organization Contract Request Form
Student Activities Office Parsons Union Building Lock Haven University
Information provided on this form will be used to create a contract! This request must be
completed and submitted at least two weeks prior to the event.
Requestor Information:
Club/Organization Name: ______________________________________Today’s Date: ______________
Requestor Name: ___________________________________Email Address: _______________________
Requestor Signature: ________________________________Cell Phone Number: __________________
Purpose for the contract: ________________________________________________________________
Performer/Service Provider Information:
Performer/Service Provider Name: ________________________________________________________
Agency: ________________________________Agency Phone #: ________________________________
Address: _______________________________Agency Fax #: ___________________________________
_______________________________Agency Email: __________________________________
Performance Information:
Date of Performance: ______________________________ Time of Performance: __________________
Location of Performance: ___________________________ Performance Duration: _________________
Performer Expected Arrival Time: ______________________________
Have you reserved the facility? ____Yes ____No (If no, you are responsible for reserving the facility
prior to submitting this form.)
Budget Information:
Negotiated Performance Fee: $________________
List Contract Inclusions (check all that apply): ____Hotel ____Travel ____Meals ____Other: _________
(Please attach a copy of all riders included with the contract)
What account will you use to pay for the performer? ______Budget Account ______Special Account
*Students & Advisors are NOT permitted to sign contracts!*
Club President Signature: _______________________________
Club Treasurer Signature: _______________________________
Club Advisor Signature: _________________________________
Office Use Only:
Date Received: ________________
Date Processed: _______________
Approved By: _________________