University of Wisconsin-Madison Division of Recreational Sports Special Event Request Form Facilities Requested *Minimum 2 weeks notice for University Organizations *Minimum one month notice for Non-University Organizations Organization Requesting Space: Type of Organization: University Department Student Organization (registered) (Check all that Apply) Athletic Department Community Club Sport Location of Event: On-Campus Event Off-Campus Event Submitted By: Telephone: Email: Fax: Local Address: Facility Requested: Area Requested: # of Fields/Courts Requested: Event Type and Description: Participant Type: Number of Participants: Students Faculty Staff (Check all that Apply) PLEASE LIST THE DATES AND TIMES THAT WE COULD TRY TO ACCOMODATE YOUR EVENT IN ORDER OF PREFERENCE. IF MORE THAN ONE DATE IS NEEDED, PLEASE NOTE THAT BELOW AND LIST ALL EXACT DATES NEEDED. Please check which applies: One Day Event Multiple Days Needed Dates: MM/DD/YY Time(s): AM/PM Requested (List all dates Needed) (Include setup and take down time) Date: Start Time: End Time: Date: Start Time: End Time: Date: Start Time: End Time: Date: Start Time: End Time: NOTE: As conditions warrant, this office will exercise the authority to cancel an event due to weather or other situations affecting outdoor or indoor space use. Equipment Requested PLEASE BE SPECIFIC WITH NUMBER NEEDED Scorer Tables Men's Basketballs Tables Badminton Nets Women's Basketballs Chairs Badminton Racquets Outdoor Basketballs Extension Cords Pinnies Footballs Clipboards Garbage Cans Rubber Bases Cones Volleyball Nets Stop Watches Volleyballs Wallyball Nets Sand Volleyballs Wallyballs Dodgeballs Equipment Bags Flag Belts Softball Bats Soccer Balls Tug of War Rope Scoreboard Controls Portable Scoreboards Softballs Date and Time Equipment will be picked up (All equipment needs to be picked up and returned to the Nat) Date: Time: Signature of Responsible Party: Date: Submit by Email OR Print Form Return Printed Forms To: UW Recreational Sports, Room 275 SERF, 715 W. Dayton Street, Madison, WI 53715 Phone: 890-0158 Fax: 262-7152 FOR OFFICE USE ONLY APPROVED DECLINED Director of Recreational Programs and Facilities Date TOWEL/EQUIPMENT ROOM STAFF Equipment Prepared By: Date Prepared: Equipment Received By: Date Returned All equipment returned in satisfactory condition? Yes No If no, provide specific details: Special Event Details PLEASE CHECK THE APPROPRIATE BOX Will there be any food sold or distributed at this event? YES NO If so please explain. Will there be any vending of any merchandise? YES NO If so please explain. Do you require any staff for clean up after the event? YES NO Do you need the equipment requested setup in the area(s) requested? YES NO Will there be any non-UW students, faculty or staff participating in the event? YES NO Will the facility supervisor need to check in on your event? YES NO If so, what will you need their services for. Please explain in detail.
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