RESERVATION REQUEST FORM DAVID W BLAKESLEE ROOM THORNTON HALL 1000

RESERVATION REQUEST FORMDAVID W. BLAKESLEE ROOMTHORNTON HALL 1000The Blakeslee Conference Room has been designated as an all University Conference Room. The Dean of the College ofScience & Engineering has been delegated the responsibility of approving use of the facility. Complete the form and return toCOSE Dean's Office, TH 323, or fax to 338.6136. THE BLAKESLESS ROOM IS NOT WHEELCHAIR ACCESSIBLE.College/Dept.PurposeDate(s) Time No# of Attendees Food Served?IF FOOD/BEVERAGES ARE SERVED, THERE IS A $.75 PER PERSON FEE PAYABLE IN ADVANCE (detailsbelow).Admin/Faculty member responsible /(Print Name)(Signature)Contact Person Campus Location Campus Ext.POLICES AND PROCEDURES FOR USE OF BLAKESLEE ROOM* Keys: Just prior to use of the room, sign out for the set of keys at the COSE Dean's Office, TH 323. These keys will be issued with theunderstanding that the individual responsible for reservation of the BR will pay for the keys, if lost, at the prevailing University rate. Uponleaving BR, all doors need to be locked and keys returned immediately.* Service of Food/Refreshments: No food or refreshments are to be served unless arranged at time of scheduling and paid for in advance.If you are serving food/refreshments please abide by the following rules:• There are two payment options: 1) You may pay at the Cashier's Office in the Admin. Building; they will need thefollowing number - CRS 74766; then present the receipt to TH 323; or, 2) You may pay via account transfer by preparing amemo directed to Accounts Payable with a cc: to Jimmy Lew and Debora Springer of the COSE Dean's Office. Be certain it is anaccount that can transfer into our account #580090-TT201-3555-91015006• You are responsible for cleanup of the room after use; if you are utilizing a catering service, arrange this with them. Thecatering service must be finished by scheduled ending time of your reservation.• All tables, chairs, and floor space are to be left clean and clear of food and paper.• If you have trash that fills up more than half of the large trash bin in the kitchen you are responsible for disposing of this sothere is space in trash bin for next reservation group.* Equipment in the Room: TV, VCR, blackboard, pull down projection screen, and internet access are available. The Dean's Office hasVCR remote and instructions. If you require additional equipment, arrange with AV located in library. 32 chairs are provided; contactShelly Cole (5.0458) if you require more. Per fire regulations, 40 people max are allowed in room.* Condition of the Room: The Blakeslee Room is to be left in an orderly and clean condition, including all tables, chairs, and floor space.Tables and chairs are to be arranged according to chart on back of reservation form. Be aware that another group may be utilizing the roomafter your scheduled time and routine custodial care between assignments is not always possible. Complaints regarding the condition of theroom should be directed to the Dean's Office.IMPORTANT NOTE:FAILURE TO COMPLY WITH THE POLICIES AND PROCEDURES OF THE BLAKESLEE ROOM MAYRESULT IN A CLEANING FEE AND DENIAL OF FACILITY USAGE IN THE FUTURE. YOUR RETURN OFTHE KEY SIGNIFIES THAT THE ROOM IS READY FOR THE NEXT SCHEDULED GROUP.ScheduledUnable to ScheduleDean, College of Science and Engineering Date

BLAKESLEE ROOMA special note to Blakeslee Users:Above is the way the Blakeslee Room tables and chairs are to be left at all times. If theroom is not arranged this way when you enter, please inform the Dean’s Office at x81571.In any case, you are responsible for leaving the room in this arrangement. Failure tocomply with this request will result in a $5.00 charge (the cost of employing a StudentAssistant to rearrange the furniture) and denial of facility usage.BLAKESLEE ROOM IS NOT WHEELCHAIR ACCESSIBLE.