General Room Request Form

*Required Information

First Name^*:

Last Name^*:

Phone Number^*:

Regent Email^*:

Class Name: (if applicable)

Class Number: (if applicable)

Project Type^*:

Project or Event Name^*:

Instructor or Executive Producer^*:

Room requested:

If you choose "Other Room" from the pull-down menu above- please type in the name of the "Other Room" desired:

2nd Choice - if your above room is not available:

Will non-Regent University personnel be invited to this activity?^*

Yes   No

If so, in what capacity?:

One time reservations:

Date requested:

Beginning time:

Ending time:

Please explain fully the activity that will take place in this room:

Does this production, rehearsal, audition or activity involve any type of SPECIAL EFFECTS (including fog, smoke, or strobe lights, etc.) or any type of WEAPON (stage, blank or otherwise... including pistols, rifles, knives, swords, clubs, brass knuckles, etc.)?

No   Yes

If so, please explain FULLY.

[NOTE: Use of any type of weapon (stage, blank or otherwise) or any type of fog or smoke, in and around the COM Building, for any type of production requires 5-business day advance notice and approval by the SCA Technical Coordinator, who will then notify & coordinate with Campus Police and CBN Building Services, if the Special Effects are approved. Use of fog, smoke or weapons in any other building on campus requires the same advance approval process via the Administrative Services office.]

Are any additional Support Rooms required for this project?

No   Yes

If Yes, please list any and all Support Rooms that are needed, and explain fully the purpose for which these rooms are requested:

Recurring Reservations:

Please explain in detail (including all dates and 'start & stop' times - from 'move-in' to 'move-out') any room request that must recur in the future: