Facility Reservation Form

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CLIENT INFORMATION
Name Name First Last
Affilation
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Day Phone Day Phone - ### - ### ####
Organization Name (if applicable)
Advisor (Student groups only)
Advisor Phone Advisor Phone - ### - ### ####
EVENT INFORMATION
Type of Space Requested
Event Type
Expected Number of Participants
Age of Participants
Affiliation of Participants

Affiliation of Participants Simmons Non-Simmons affiliated
Will food be served?

Will food be served? Yes No
Date of Event (1st Choice) Date of Event (1st Choice) / MM / DD YYYY
Start Time of Event (1st Choice) Start Time of Event (1st Choice) : HH MM AM/PM
End Time of Event (1st Choice) End Time of Event (1st Choice) : HH MM AM/PM
Date of Event (2nd Choice) Date of Event (2nd Choice) / MM / DD YYYY
Time of Event (2nd Choice) Time of Event (2nd Choice) : HH MM AM/PM
End of Event (2nd Choice) End of Event (2nd Choice) : HH MM AM/PM
Additional Comments