Event Application Form Event Application Form Name of Organization * RequiredName of Applicant First Last Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Daytime PhoneEmail * Required Facebook LinkTwitter LinkEvent InformationType of Event * RequiredDescribe in detail the event and activities: * RequiredEvent Date - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Event Start Time * Required : HH MM AM/PM AM PM Event End Time * Required : HH MM AM/PM AM PM What time would you like to enter the space on the day of the event? : HH MM AM/PM AM PM Will Setup/ Take-down occur on the day of the event?YesNoGuest(s)/ Participant(s) entrance time(s) each day:YesNoEstimated Attendance?Will registration ticket(s) or admission fee(s) be required to attend this event?YesNoStaging Information:Please indicate the quantity of equipment neededStage size(s):Table(s):Chair(s):Podium(s):Easel(s):Will entertainment be provided for this event?YesNoA/V Information:Please indicate the quantity of equipment neededVideo/ Projection Screen(s):Sound Monitor(s):Speaker(s):Power point w/sound capabilities:Video Monitor(s):Projector(s):CD/DVD Player(s):Internet Access:YesNoMicrophone(s) - Lavalier(s):Handheld Wireless:Handheld Corded:Are you interested to know more about our Audio & Lightining packages for your eventYesNoInformation will be provided by the Event Manager upon receipt of the Event ApplicationCatering:Will event be professionaly catered?YesNoLicensed Caterer Name:Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country PhoneWill alcohol be served at the event?YesNoOutside caterering company will be charged a 10% gross sales fee prior to the event. Would like to know more information about catering options at UIC Forum?YesNoFacility Information:Do you have any security concerns?YesNoNote: UIC Forum will make final determination on security personnnel.If yes‚ please describe:Will there be vendors selling merchansise?:YesNo(Contact Event Manager for more informaion)How do you plan to publicize the event?Note: You cannnot advertize your event prior to approval. Will there be live media coverage during the event? If yes‚ please describe:Would you link UIC Forum to promote your event on website calendar, Twitter, or Facebook ?:Please read all of the information herein before making any commitments for event services or equipment.Official Challenge PolicySubmitting this application is not confirmation to conduct your planned event. Confirmation‚ if granted‚ will be in the form of a UIC Forum Contract issued to the organization or person responsible for conducting the event. In addition‚ a hold is only tentative and is not confirmed until a signed University contract and certificate deposit is received and approved.PLEASE DO NOT SEND OUT NOTICES‚ PUBLICITY‚ INVITATIONS‚ ETC. Prior to receiving and executing a space agreement/contract.I understand that‚ if event-related information herein changes (i.e. performers‚ date‚ etc.) this application shall be invalid and a new application may be required. Any changes are to be made in writing. By initialing below‚ I acknowledge that I have read all the information contained in this application‚ understand it‚ and will abide by it. I also understand the date the Forum may be holding for me is tentative and that an application for an event does not constitute a University agreement.Date - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Initials * RequiredBelow math question is a check to prevent against spam emailsQuestion: 1+ 5 = * RequiredEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.