Enrolment Services D105-2055 Notre Dame Avenue Winnipeg, MB R3H 0J9 Ph: 632-2508 FAX: 697-4738 Application for Use of Facilities Name of group or organization requesting facilities: Name of person in charge, who will be present at event: Billing/Mailing Address: City/Town: Prov.: Postal Code: Bus. No.: Home No.: FAX No.: Cel No: Area Required: Classroom Lecture Theatre Selkirk Lounge θ θ θ Gym North Gym Display Areas θ θ θ Prairie Lights Boardroom Other: θ θ θ Reason for use of Facility: Date(s) required: Time(s) required: Set-up requirements (specify): ______________________________________________________________________________________ Admission to be charged? Yes No θ θ Special liquor permit required? Yes No θ θ Parking required? Yes No If yes, applicant must email: θ θ Audio Visual required? Yes No If yes, applicant must call Media Services @ 632-2231. θ θ Satellite Conference Services? Yes No If yes, applicant must call Satellite Services @ 632-2376. θ θ (Please advise if videotape is required.) On behalf of the above named group or organization, I hereby apply for permission to use the facilities described and agree to all the Terms and Conditions outlined on the reverse side. I also understand and agree to follow all emergency procedures as outlined in attached brochures. Date: Signature: F O R O F F I C E U S E O N L Y Facility Assigned: Cost of Facilities $ GST: $ Total Cost: $ Application Approval: Room Allocations Coordinator Date of Approval Copies to:
Enrolment Services D105-2055 Notre Dame Avenue Winnipeg, MB R3H 0J9 Ph: 632-2508 FAX: 697-4738 Application for Use of Facilities Name of group or organization requesting facilities: Name of person in charge, who will be present at event: Billing/Mailing Address: City/Town: Prov.: Postal Code: Bus. No.: Home No.: FAX No.: Cel No: Area Required: θ Classroom θ Lecture Theatre θ Selkirk Lounge θ Gym θ North Gym θ Display Areas θ Prairie Lights θ Boardroom θ Other: Reason for use of Facility: Date(s) required: Time(s) required: Set-up requirements (specify): ______________________________________________________________________________________ Admission to be charged? θ Yes θ No Special liquor permit required? θ Yes θ No Parking required? θ Yes θ No If yes, applicant must email: Audio Visual required? θ Yes θ No If yes, applicant must call Media Services @ 632-2231. Satellite Conference Services? θ Yes θ No If yes, applicant must call Satellite Services @ 632-2376. (Please advise if videotape is required.) On behalf of the above named group or organization, I hereby apply for permission to use the facilities described and agree to all the Terms and Conditions outlined on the reverse side. I also understand and agree to follow all emergency procedures as outlined in attached brochures. Date: Signature: F O R O F F I C E U S E O N L Y Facility Assigned: Cost of Facilities $ GST: $ Total Cost: $ Application Approval: Room Allocations Coordinator Date of Approval Copies to:
Application-for-Use-of-Facilities-Notre-Dame-Campus1.docx