| ASSIGNED ROOM: |
Fairhill Center
Room/Event Scheduling Request Form |
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Applicant
Confirmation
Initials: |
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| 12200 Fairhill
Rd., Cleveland, OH 44120 (216)
421-1350 X160 Fax (216) 421-8874 |
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Please complete a separate form for each room and
date requested |
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| Host Organization: |
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| Address: |
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| Contact Person: |
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Contact Phone Number: |
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| Name Of Event: |
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ROOM REQUESTED: |
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| Date Of Event: |
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One Time On
Going |
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| Time Of Event: |
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AM PM |
TO |
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AM PM |
(list total time required) |
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| Number Attending: |
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Organization Status: |
Campus |
Non-Profit |
Commercial/Other |
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Available Room Configurations
Mark Desired Set-Up - Not All Configurations Available In All Rooms |
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| CLASSROOM |
CONFERENCE |
BANQUET |
THEATER |
HOLLOW SQUARE |
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| U-SHAPED |
VENDOR |
OPEN |
NONE |
SPECIAL |
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| Room Set Up To Be
Done By: |
Fairhill Staff |
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Event Representatives |
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| TABLES AND CHAIRS |
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| Chairs |
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Round |
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Serving |
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Large |
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Speaker's |
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FOOD SERVICE
NO KITCHEN FACILITY AVAILABLE FOR PREPARATION OR CLEAN UP |
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| Will There Be
Meals? |
Yes |
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No |
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| If Yes, Will It Be: |
Catered |
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Potluck |
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Brown Bag |
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Other |
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ADDITIONAL REQUESTED SERVICES
These Services may be applied by Fairhill Center |
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| Protective
Services: |
+ |
Officers @ |
$25.00 |
per hour per Officer |
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| Will Additional
Set-ups or Changes Be Needed? |
Yes |
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No |
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| If Yes, Please
submit additional forms explaining additional set ups and changes. |
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RENTABLE EQUIPMENT
CHECK ALL REQUESTED ITEMS - SUBJECT TO AVAILABILITY |
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Coffee Maker: 3-pot, 30 cup, 100 cup |
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Tabletop Podium: Microphone
No Mic |
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Chalkboard w/ chalk & eraser |
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Floor Microphone |
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Flipchart Easel w/ pad and markers |
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Table Microphone |
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LCD Projector |
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Floor Podium: Microphone No Mic |
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Overhead Projector |
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Piano: Upright Keyboard
Baby Grand |
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Slide Projector |
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Cassette Recorder |
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Projector Screen |
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Tripods |
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Internet Access |
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Mobile Microphone |
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TV Monitor w/VCR w/DVD |
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Other: |
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| All rented equipment must be returned clean and undamaged to
avoid extra charges |
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| Other Information: |
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