Event:

Date(s): month January February March April May June July August September October November December date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 year 2008 2009 2010 2011 2012 2013 2014 2015

Start Time: select 12:00 12:30 1:00 1:30 2:00 2:30 3:00 3:30 4:00 4:30 5:00 5:30 6:00 6:30 7:00 7:30 8:00 8:30 9:00 9:30 10:00 10:30 11:00 11:30 select am pm    End Time: select 12:00 12:30 1:00 1:30 2:00 2:30 3:00 3:30 4:00 4:30 5:00 5:30 6:00 6:30 7:00 7:30 8:00 8:30 9:00 9:30 10:00 10:30 11:00 11:30 select am pm

Organization’s Name:

Director’s Name:

Address:

City    State (click here) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming    Zip

E-mail address:    Fax:

Director contact numbers: Home:  Cell: 

Day of event: select Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Location(s): Bollman Gym    LifeSports Center    Shirk Stadium     Tennis Courts
North Field     Kelchner Field     Science Field     Football practice field

Approximate # of participants:    Expected income:

This income benefits:

Set-up requested: (Please be specific as possible)

(Check all that apply and specify number needed in the space provided)
Restrooms
Tables (#)
Chairs (#)
Locker Rooms

• Men’s (#)
  
• Women’s (#)

Extension Cords (#)
Scoreboard (Bollman Gym/Shirk Stadium)
Flip Score Charts (#)
Sound System (Bollman Gym/Shirk Stadium)
Portable Sound System
Bleachers (Bollman Gym Only) How many sides? (1,2,3,4)
Benches (Life Sports Center Only) (#)
Divider Nets between Courts (Life Sports Center Only)
Volleyball Nets (#)
Racquetball Courts (#)
Training Room (If applicable)
Storage (If applicable)
Concessions (If applicable) Ticket Sales
On Duty Custodian
Event Staff needed
Other Requests:

• Please fax a diagram of the necessary set-up and a copy of your organization’s
  certificate of liability insurance in the amount of one million dollars to 610-921-7566.
  
  
• A copy will be sent to you with either approval or denial.
  

Thank you for your reservation. We will inform you if there is a problem meeting your requests. If you have any other questions, please contact Bev at the athletic office at (610) 921-7535 or email bminjock@alb.edu.

In order to help prevent abuse of this form, please enter the FOURTH letter of the name of this college in the space provided. Please use lowercase.