You must read and agree to the following rules and regulations for the R.A.C. before filling out an on-line request:



• Facilities will only be used for nonprofit purposes.
  
• Organization must comply with all applicable Office of the Chaplain policies and regulations.
  
• The R.A.C. is a non-smoking facility.
  
• No alcoholic beverages can be served in or on the premises.
  
• Organization agrees that it will be financially responsible for all damage or all harm to facilities; responsible for returning furniture/equipment to proper place after use; and if food is used or prepared, to dispose of trash properly.
• This application must be completed entirely or it will not be accepted.

• If rules or regulations are violated, the Office of the Chaplain reserves the right to deny an organization's request for room reservations. All cancellations should be submitted with 24-hour notice.

  
  

• This form must be submitted at least two weeks prior to the event. Requests received after the two-week deadline may be rejected without further consideration.

  
  

• A RESERVATION IS NOT FINAL UNTIL YOU RECEIVE CONFIRMATION FROM THE OFFICE OF THE CHAPLAIN.

  
    I have read and agree to the rules and regulations set forth by the Office of the Chaplain concerning room use.
   

  Contact Information

  
  
    Today's Date (mm/dd/yy):
  
    Department or Organization:
  
    Status   Student   Staff   Faculty   Non-University
  
    Person Making Reservation (note: person making reservation takes responsibility for event):
   
  
    Your email address: (e.g.: you@aol.com)
    Your phone number (with country, city, area codes):

  Address:

  
  

    Secondary Contact:
    Secondary email: (e.g.: you@aol.com)
    Secondary phone number (with country, city, area codes):

   

  Room Request

    WILL YOU REQUIRE USE OF THE LIFT FOR WHEELCHAIR ACCESS?
    Yes   No
  
    First Choice Whatever is Available Main Room (70 people) Conference Room (001) (20 people) Mini-Conference Room (0004) (16 people)
   on Date (mm/dd/yy):
  
    Reservation begin time: am pm Reservation end time: am pm
  
  
    Second Choice Whatever is Available Main Room (70 people) Conference Room (001) (20 people) Mini-Conference Room (004) (16 people)
    on Date (mm/DD/yy)
  
  
    Reservation begin time: am pm Reservation end time: am pm
  
  
    Type of Event   Meeting   Lecture   Conference   Reception   Other - if other, please give type
   

    Multiple dates for the event requested above can be described in the space below.
   

    Full Description of Event (Subject, Program, Titles, Guests, etc.) (this information is required):  
  
  

  Expected attendance:
    # Penn ugrad students # Penn grad students # Faculty/staff
    # Alumni # Non-University guests

  Will food/beverages be present/served at this event? No Yes. If yes, please complete this section. Will you recquire use of the kitchen? No Yes Type of food/beverage that will be present or served at the event:

   

  Will audiovisual equipment be needed? No Yes If Yes, please complete this section. Microphone Overhead Projector TV/VCR Standing Screen

   

  Will you recquire any of the following additional equipment? No Yes If Yes, please complete this section. Easel Large Folding Table Podium Keyboard Drums

   

  Will a special room configuration be needed? No Yes If Yes, please complete this section. Please indicate your special room set-up needs: Conference Theater Style Head Table Auditorium Other

  Will speakers or dignitaries be featured/present at the event? No Yes Yet to be determined (If yet to be determined, please notify this office when arrangements are finalized) If yes, please complete this section. Name and title of speaker #1: Name and title of speaker #2: List the names of any invited dignitaries and/or government officials * (if not listed as speakers above): * If you are expecting government officials, please contact Carol de Fries, Office of Government, Community, and Public Affairs, at 215-898-5453.

  
  
  
    Additional Comments:
  
  

If you would like to print your reservation request, please choose File/Print on your browser before clicking the Submit button. Submitting your request clears the form.

If you get an error message after choosing Submit:

1. There are mandatory fields. Failure to fill out this form completely will produce a message that you haven't completed the form. Just correct the one you missed and resubmit.
   
   
2. An error message that doesn't refer to the mandatory fields but states that your form could not be processed means the system is busy. Please wait a few minutes and submit again.

Questions? Please call (215) 898-8456 or stop by the Relgious Activities Common during business hours.