External Request to Have an Event at MSM

Please Note: External Event Requests require a 4-week lead time and are subject to the discretion of Morehouse School of Medicine (MSM). MSM reserves the right to refuse event requests and review the program of those approved. Approved events will generally support the mission and vision of MSM.

INFORMATION

Please Note: All events are granted 2 hours for prep and 2 hours for break down time. All events will incur a standard 4 hour charge on the front and back end for set-up and break down time for MSM IT/AV, Catering and Facilities.

Event Date? * +

Start Time: *

End Time: *

Set-up Time: *

Breakdown Time: *

Facility Requested: *

Rooms Requested: *

Organization Name: *

Organization Address: *

Contact Person: *

Title: *

Phone (work/cell): *

Email: *

Event Type (choose one): *

If "Other," describe event

Is there a cost for admission? *

If yes, amount charged?

Attendance expected? *

Is the event open to the public? *

Is the event going to be televised? *

If yes, indicate TV network identification

Is the event going to be taped for radio broadcast? *

Is there a special recording of the event for sale? *

Are audio/visual or IT services needed? *

If yes, please explain

Will you serve alcohol? *

Insurance Requirement (for General Counsel): *

Is this event associated with a Morehouse School of Medicine department or unit? *

If yes, you must complete the following questionnaire

1. Morehouse School of Medicine organization's name:

2. Contact Person:

Title:

3. Phone:

4. Email:

Is this event a fundraiser for the sponsoring organization? *

If yes, what amount of percentage will the sponsoring organization receive?

DO NOT COMPLETE FEES SECTION

Fees:

Facility Usage Fee for all space discussed: $

Employee Fee (minimum of 4 hours):
o Custodial Services/Maintenance
($21.50/person/hr) $
o Public Safety ($35.00/officer/hr) $
o AV/IT ($45.00/person/hr) $

AV Equipment Fee (if needed): $

Parking Fees (if paying in advance): $
o $5.00/vehicle

Total Fees (due before event): $

Important Information

Licensee agrees to furnish Morehouse School of Medicine with a policy or certificate of public liability with coverage in an amount as determined by Morehouse School of Medicine. Refreshments CANNOT be served in some facilities.

Sign and Date