Brookdale Community College
765 Newman Springs Road
Lincroft, NJ 07738
Application For Use of College Facilities

Items marked * must be completed.

Event Information

Title of Presentation:	*	Type of Event:	*
Presenter:		Room Name and Number (e.g. MAN 105)	*

Estimated Attendance:	*	click for important information regarding room requests
Date(s):* Choose up to four dates by clicking on the calendar icon(s). If you have a more complex date range, write it in "Additional Requests" below.		* Event Time:	Start: End:

*Set Up Description:

INCLEMENT WEATHER ADVISORY

Equipment and Personnel

Police/Safety/Security

Custodial

Video/Teleconferencing

Catering

Technology

	Portable CD Player		TV/VCR		DVD Player		LCD Projector
	Overhead Projector		Internet		Network		Microphone (Lavalier)
							Microphone (Hand-Held)

Additional Requests:

Requestor/Sponsor Information

Name of Organization:	*	Contact Person	*
Address:	*	City/State/Zip	*
Check if you have a campus address
Business Phone/Ext.	*	Fax:
Cell Phone:		Email:	*
Account Code:	— — Check if you do not have an Account Code

Approval

I show by this agreement that I understand that I am not to advertise or in any way promote or publicize this program until I have received written approval from Brookdale Community College. I declare that I am an authorized agent of a responsible organization, and as such, make application to Brookdale Community College for the use of college facilities. I warrant that the applicant organization and members will observe all regulations of the College, and will pay promptly any agreed fees, and that the applicant will exercise the utmost care in the use of school premises and will make full restitution for any damage arising from the applicant's use of said premises. If the applicant organization is a Brookdale department or organization, I understand that my account will be debited automatically.
A Certificate of Insurance is Required.
By clicking "Submit", I indicate that I agree to the terms and conditions of this application NOTE: Submission of this form does not guarantee a room reservation. Please print this page for your records before hitting "submit."