Facility Use Permit

Facility Use Permit

Perelman Quadrangle


Group:      Event:

Starting Date:

Start Time:      End Time:      Day(s):

Ending Date:      Group Size:     

Group Affiliation/Status:

Areas:
     

Additional Approvals Required (Yes or No):

Tent: Other Temp Structure: Food/Beverage: Signage:
Amplified Sound: Audio Visual: Alcoholic Beverages: Grill:

Contact Information - Organization's Event Coordinator


Name:      Email:     

Home Phone:      Cell Phone:

Address:

Issued by: Katie Bonner, Student Affairs (215)898-6533                    DATE: 12/13/2017
                Laura Carney, Perelman Quadrangle (215)898-5552

THE EVENT DIRECTOR IS RESPONSIBLE FOR PRESENTING ONE COPY OF THIS FORM TO THE DEPARTMENT OF PUBLIC SAFETY, SECURITY PERSONNEL OR UNIVERSITY OF PENNSYLVANIA STAFF MEMEBERS UPON REQUEST. GROUPS ASSUME ALL COSTS RELATED TO THE USE OF THER AREAS INDICATED AND FURTHER ACCEPTS FULL FINANCIAL RESPONSIBILITY FOR ANY DAMAGES WHICH MAY RESULT FROM THE GROUP'S USE. GROUPS MAY ONLY USE THE FACILITIES PERMITTED FOR THEIR USE AS INDICATED ABOVE.

PLEASE NOTE: CANCELLATIONS MADE WITHOUT APPROPRIATE 24 HOUR NOTICE, THE INDIVIDUAL OR GROUP WILL BE BILLED FOR SERVICES

COPIES TO:
        

Special Instructions or Needs:

I have read and agree to abide by all University of Pennsylvania polices.