ROOM RENTAL SET-UP AND CLIENT INFORMATION FORM

ROOM RENTAL SET-UP AND CLIENT INFORMATION FORM THE BASICS COMPANY NAME: _____________________________________________________________________________ CONTACT NAME: _____________________________________________________________________________ ROOM RENTAL NEEDED FOR: __________________________________________________________________ CONTACT PHONE NUMBER: _________________________CONTACT E-MAIL:___________________________ Please list your top three preferences for room rental dates and times: 1) _______________________________________________ 2) _______________________________________________ 3) _______________________________________________ ***We will work to secure your first preference, but in the event we have a conflict in our schedule we will work to secure one of your three dates. ROOM SQ. FT. THEATR E STYLE CLASSROOM STYLE RECEPTIO N STYLE 250 # OF TABLES AVAIL. # OF CHAIRS AVAIL. LCD OVERHEAD PROJECTO R YES PHONE LINE AVAILABLE COST Full Day / Half Day $ 450 / $300 Belk Action Center 2318 150 80 19 (6 ft. x 3 ft.) 150 NO AV NEEDS AND FEES PLEASE CHECK ALL THAT WOULD APPLY TO YOUR EVENT: ______ Sound System (includes podium with microphone attached to podium. Use of CD player, tape deck, and MP3 input) $100.00 ______ Video/Data projection (includes in ceiling LCD projector, Computer with internet connection in podium connected to projector, Inputs for laptop to projector, use of DVD and VHS players) $200.00 (needs option number 1 for sound) ______ Wireless microphones (2 wireless microphones either Lavaliere or Handheld) $100.00 (needs option number 1 for sound) ______ Panel Microphones (up to 4 panel microphones) $100.00 (needs option number 1 for sound) ______ Overhead Projector ______ Audio Mixer (4 microphone inputs) ______ Flipchart Stand w/ Pad and Markers ______ Laser Pointer ______ Sign Easel ______ Surge Protector ______ Skirted Cart $40.00 $25.00 $25.00 $25.00 $10.00 $5.00 $15.00 ***All AV setup and testing needs to be done during normal business hours. Normal setups before event included in price. ROOM SET-UP PLEASE CIRCLE ONE: THEATER STYLE CLASSROOM STYLE RECEPTION STYLE NUMBER OF TABLES NEEDED: __________________________________________________________________ NUMBER OF CHAIRS NEEDED: __________________________________________________________________ *The Charlotte Chamber does not set up for room rentals. This information assists us in our booking and events calendar. MISCELANEIOUS FEES Clean-up fee (if rented space is left in poor condition) Audio Visual Staff Assistance Broken table Broken chair Extra AV assistance $50.00 $100.00 per hour $100.00 per broken table $75.00 per broken chair $50.00 per hour Please complete this form and fax to Laura Meyer at 704-338-5457. You will be contacted in regards to the availability of your room rental request.