Fillable Supplemental Facility Request Updated7.21.15 (Las Positas College)

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Supplemental Facility Request Updated7.21.15 (Las Positas College)

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7/21/15
Today’s
Date: __________________________
EXTERNAL SUPPLEMENTAL FACILITY REQUEST
Organization Name: ___________________________________________ Contact Name: _______________________
Contact E-Mail: _______________________________________________Telephone: __________________________
Billing Address: _________________________________________________
City: ____________________________________________ Zip: __________
Event Title & Description:
_____________________________________________
_______________________________________________________________________
PERFORMANCE
ATHLETICS
TECHNICAL REQUIREMENTS:
Gymnasium Lights: House Special
Volleyball Nets: #____
w/Electricity
____
Basketball Hoops: #
Bleachers: 1 side 2 sides
Clock: Portable Main
Drape: Open Close Moveable
Microphone: #_____ Type _________
Sound System
Screen Projector Laptop
Piano: Steinway
Grand Upright
Technical Details: __________________
Main Theater
Black Box
Amphitheater
Dressing Rooms
4000 Lobby
Box Office
Concession Stand
Green Room
Cover Floor w/mats
LECTURE/CLASS/MEETING
Locker Rooms
Concession Stand
Synthetic Field
Instr Pool (1)
_________________________________
BASIC REQUIREMENTS
2420 801 Pool Lights* Hot Tub Podium Lectern
Main Theater Black Box Pool House Restrooms
# ______ Tables
Track Track Field Lights* # ______ Chairs
# ______ Trash Cans
# ______ Canopies
Location of Tables/Chairs: ____________
1726 Conference Room
Room: _______________________
Room: _______________________
Room: _______________________
Other: _______________________
Field House
R
estrooms
Athletic
D
etails
:
_________________
__
__
___________________________
____________________________
__
_
_____________________________
_________________________________
WEEKEND RESTROOM LOCATION: RESTROOM CHECK REQUIRED: YES NO
SIGNATURES: (By Signing This Request, the Applicant Agrees to Abide by the LPC Facilities Use Policy)
________________________________________________ Date: ___________________
Requester
________________________________________________ Date: ___________________
Administrative Services Department/Sheri Moore
INTERNAL USE ONLY
Walk-Thru Required: Yes No Date of Walk-Thru: ________________________________________
Cert. of Liability Rcvd: _____________________ Date Formal Confirmation: _________________________________
Banner # _________________________________ Theater/IT Support Provided By: ____________________________
DAY OF WEEK
MONTH/DATE/YEAR
ENTRY TIME
EVENT TIME
EXIT TIME
C. Rosefield M. Rinaldi C. Hornbaker
Athletics: D. Miller M. Hargiss
B. Eddy J. Santos
Other:
CHECK IF A LAYOUT DIAGRAM OR ADDITIONAL INFORMATION IS ATTACHED
PLEASE INCLUDE ANY REHEARSAL TIMES ON THE SCHEDULE
w/Lights*
Comp Pool (2)
____________________________
# Attendees
# Spectators
Type of Event:
Public Private
Class or Club Event:
Yes
No
Food at Event:
Yes No
Fresh & Natural Cater:
Yes
No
Admission Fee:
Registration Fee:
Proceeds Used For:
* Lights - Time on: __________________
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Supplemental Facility Request Updated7.21.15 (Las Positas College)

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Completed 24 July 2020

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