What is the Event or Program? ______________________________________________________

DATE of Event: ________________________

TIME of Event: From: ________________________ To: ________________________

Your organization or group? ________________________________________________________

Approximate # of people attending? ______________

Will participants be charged to attend? (If so please explain)______________________________

Facility needed (please check):

DSC Ballroom Rangerette Gym Masters Gymnasium DSC Conference Room

Dodson Auditorium Pool Carpeted Gym Aerobics Floor

Devall Room Other___________________________________________________________

Contact person for the event:

Name____________________________________________________________________________________

Phone Number or KC Extension ___________________ e-mail ______________________________________

Items needed: (free of charge if available) Lectern Piano American & Texas fl ags

Tables & Chairs:

# of Round Tables / Chairs? _______ / _______

# of Long Tables / Chairs? _______ / _______

# of Serving Tables / Chairs? _______ / _______

# of Registration Tables? ________

NOTE: Facility Coordinator will check the availability of the desired area. If it is available, it will be placed on the KC Master Calendar. Please submit requests in ample time to assure availability.

Internal Facility Request FormKC-Sponsored Events

Technical Items & Services Needed (Audio & Video)If you selected above that you need technical items such as PA systems, laptops or projectors, please fi ll out the information below. Technical items that are available are free to use, however some services, such as a lighting/sound technician will cost extra.

Do you need technical items and/or services for your event? Yes No

If you checked yes, please name the audio items needed below:

Use of Public Address (PA) System CD Player Other_________________________

Do you need a lighting/sound technician on hand?

Yes, I need a Lighting/Sound Technician No, I do not need a Lighting/Sound Technician

If you checked that you need a PA System, please fi ll out the information below:

What type and what quantity of microphones & equipment do you need?

Wireless microphone – quantity_______________ Lapel microphones – quantity_________ Microphone (regular) stands – quantity_________ Direct (DI) Boxes – quantity___________ Microphone (boom) stands – quantity__________ Instrument Hook-ups – quantity________ Other Items (specify)_________________________________________________________________

Approximately how many feet of sound cable will this event require? ____________feet

Do you need video services and/or items for this event? Yes No

If you checked yes, please name the video items needed below:

Projector – quantity__________ Screen to project items on – quantity______________ DVD player – quantity___________ Laptop with PowerPoint – quantity________________

Video Camera – quantity_________

Approximately how many feet of video cable will this event require? ____________feet

If providing your own laptop, specify if it is a: Apple/Macintosh IBM (PC)

If you answered yes to Mac, do you have the proper adaptors? Yes No

Additional Notes for our department: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________