COM Room Request Form — Submit a Request

(*Any field surrounded by * is a required field*)

1. Person Requesting


*Name*
*Address*
*E-mail*
*Phone (Day)*
Mail Location



2. Event Information


*Name of Event*
*Type of Event*
*Sponsoring Department*
Speaker Name
High Profile Speaker? Yes No



3. Choose A Room
Preferred Room Space
*Number Attending*
*Start Date(MM/DD/YYYY)*
*End Date(MM/DD/YYYY)*
*Event Start Time (h:mm)* AM PM
*Event End Time (h:mm)* AM PM
*Start Time for Setup (h:mm)* AM PM
*Food Served?* Yes No
*Alcohol Served?* Yes No



4. Event Open To—
Members Only
All University
Members and Guests
Students and Faculty
General Public



5. Financial Arrangements
Yes  No   Amount
*Admission*      
*Registration*      
*Donations*      
*Items for Sale*      



6. Contact Person for Request


*Name*
*Phone (Day)*
Address
*Email*
Position in Organization
Mail Location
*Affiliation* Academic Health Center UC East Non-COM
UC West Other

*Status* Student
Faculty/Staff
Non-University



7. Billing Arrangements (if applicable)


Send Bill To
UCFLEX Number*
* UC Sponsored Organizations Must Supply UCFLEX Number



8. IT Services Needed
Yes No
Yes  No  Amount
*Podium*
*Microphone*
*Projector*
*Screen*
*Speakers*
*Laptop*
*Video conferencing equipment*
*Video capture/streaming*
*Web conferencing*
Other



I/We acknowledge that the rules and regulations governing the usage of College of Medicine facilities. I/We acknowledge that my/our organization in the absence of posting a bond, will be financially responsible (1) for any damage caused by my/our use of Kresge Auditorium or College classroom; and (2) for any charges assessed by the College for services provided in connection with the above event.


I/We also acknowledge that the COLLEGE OF MEDICINE RESERVES THE RIGHT TO APPROVE OR DISAPPROVE WITHOUT JUSTIFICATION THE USE OF ANY COLLEGE FACILITY. It is further acknowledged that the College of Medicine reserves the right to cancel the Agreement FOR USE OF KRESGE AUDITORIUM AND CLASSROOMS any time prior to the date of the scheduled event and that the undersigned and his/her/their organization will hold harmless the College of Medicine, the University of Cincinnati, and any of their employees for taking such action.


I/We acknowledge that I/we received a copy of the SPECIFIC RULES AND REGULATIONS FOR THE USE OF KRESGE AUDITORIUM.


I/We acknowledge and agree to adhere to the rules and regulations which govern the College of Medicine Facilities.


Food / Beverage Policy
No food or beverages are permitted in classrooms or Kresge Auditorium




Comments/Additional Dates/Special Instructions




Yes, I understand. (If this box is not checked, we will not be able to process your request.)