500 Forum Drive
Rolla, MO 65401

ECC Facilities Request
ECC-Rolla
Phone: (573) 458-0165
Fax: (573) 368-4353

Fields in red are required.

Date: MM/DD/YY
Client:
Event Name: Event Date(s): or Start Date Stop Day: if recurring
Attendance:
Event Type:
Meeting Banquet Performance Camp
Workshop Party Contact Table Other
Room Number(s):




Event Occurance: Single    Weekly    Bi-Weekly    Monthly    Day(s) of Week: Mon Tue Wed Thu Fri Sat Sun
Setup Time:
(ex: 00:00 am)
 Start Time:
(ex: 00:00 am)
 End Time:
(ex: 00:00 am)
Contact Name:
Address:
City: State Code: Zip:
Phone: ex: (000)000-0000 Fax: Ext:
Email:
Is this an official ECC event? Yes
No
If Yes, name of authorizing Dean:
Event Set Up and Instructions:
Podium:    Microphone:
Special Instructions:
Food Set Up and Instructions:
Display Event on Web: Y N
Event Description for Web:
Room Set Up Requested: (check one)
Row Seating
Row Seating
Conference Seating
Conference Seating
Dining Seating
Dining Seating
Classroom Seating
Classroom Seating
For Internal Use Only
Deposit Due Upon Receipt of Signed Contract      Certificate of Insurance Required Prior to event
Contract Amt: Deposit: Received:
Balance: Due: Received:
Certificate of Insurance Received: Admission:
Booked By: Extension #:
Legal Text

By submitting this form, I agree to the above text and will print, sign and fax the next page to make the contract binding.

Note: This is not confirmation of your reservation. You will be contacted by an ECC representative once the event has been approved.