Event Request Form

Day of Event Contact*

First Last

Email*

Group / Organization Name / Association*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Day of Event*

Start Time (includes set-up)*

:

End Time (includes break-down)*

:

Desired setting/location

Please describe the kind of room you would like to use.

Title of event*

Type of event*

Meeting
Lecture
Reception
Conference
Expressive Activity (note policy)
Film Production (note Film Venue Guidelines and Fee Schedule)

Number of Participants*

Do you plan on serving food?*

Yes
No

*fees may apply*

Will you be serving alcohol?*

Yes
No

*fees may apply*

Do you need to use AV equipment?*

Yes
No

*fees may apply*

Would you like to offer continuing education credit?*

Yes
No

Event Details and Purpose*

Please upload any relevant attachments (proof of liability, for instance)

Max. file size: 15 MB.

Please enter the email address at which you would like to receive notifications about this reservation.

Liability*

I agree.

All information submitted complies with the institutional facilities use policy (Policy 4.105),
to the best of my knowledge.

User agrees that all participants, guests, and subcontractors of the User are under the direct and complete supervision and control of the User. As such, User is liable for to the extent damages resulting from participant, guest, and subcontractor utilization of the facilities and services provided by UNTHSC In addition, the terms and conditions of this agreement do not require UNTHSC to relinquish its control of its facilities and services to User. UNTHSC retains the right to require User, or any of its participants, guests, or subcontractors, to leave the UNTHSC premises if UNTHSC feels that circumstances require it. UNTHSC assumes no responsibility for loss or theft of personal property or damage to personal property of User or any of its participants, guests, or subcontractors, except to the extent arising from the negligence or willful misconduct of UNTHSC, its employees, contractors or agents. User shall indemnify and hold harmless the University of North Texas System, University of North Texas Health Science Center, its officers, and employees against any and all claims for loss, bodily or personal injury, or damage to persons or property, including claims of employees of User or its agents, to the extent arising out of the negligence or willful misconduct of User, its participants, guests, and subcontractors on or in UNTHSC buildings, properties, or facilities. UNTHSC assumes no liability whatsoever for any property placed by User, its participants, guests, and subcontractors in UNTHSC buildings, properties, or facilities or for any bodily or personal injury to User, its employees, participants, guests, and subcontractors, except to the extent such liability arises from the negligence or willful misconduct of UNTHSC, its employee, contractors or agents.