Spreadsheet: 145afcbd-25ad-4882-94dc-18b24ac5cf7d
Sheet: Sheet1

VALDEZ CONVENTION AND CIVIC CENTER
314 CLIFTON DRIVE, P.O. BOX 1849, VALDEZ, ALASKA 99686
PHONE: (907) 835-4440          FAX: (907) 835-2472
APPLICATION FOR USE
(In conjunction with "Conditions for Use")
EVENT NAME: |  |  |  |  |  |  |  | EVENT DATE(S):
APPLICANT/ORGANIZATION: |  |  |  |  |  |  |  |  | EVENT SCHEDULE:
CONTACT NAME: |  |  |  |  | CONTACT PHONE #: |  |  |  | EARLY ENTRY TIME:
MAILING & PHYSICAL ADDRESS: |  |  |  |  |  |  |  |  | EVENT START TIME:
 |  |  |  |  |  |  |  |  | EVENT END TIME:
CONTACT EMAIL ADDRESS:
APPLICANT CATEGORY:  (FOR DETERMINATION OF RENTAL RATE OR PACKAGES/SERVICES DISCOUNTS)
 | COMMERCIAL BUSINESS |  |  |  | NON-PROFIT |  |  |  |  | PUBLIC ORGANIZATION
 | PRIVATE LOCAL RESIDENT |  |  |  | (IRS LETTER OF DETERMINATION REQUIRED) |  |  |  |  | AUXILIARY ORGANIZATION
 |  |  |  |  | GOVERNMENT AGENCY |  |  |  | (AS DESIGNATED BY CIVIC CENTER POLICY)
ROOM(S) REQUESTED:
 | TOTAL FACILITY |  |  |  | CONFERENCE ROOM |  |  | THEATRE/MEZZANINE
 | 3 BALLROOMS |  |  |  | LOBBY |  |  | GREEN ROOM
 | 2 BALLROOMS |  |  |  | MAIN HALL |  |  | DRESSING ROOM(S)
 | 1 BALLROOM
ANTICIPATED NUMBER OF ATTENDEES: |  |  |  |  |  | _________
IS EVENT OPEN TO THE PUBLIC? |  |  |  |  | YES |  | NO
WILL ADMISSION BE CHARGED? |  |  |  |  | YES |  | NO | IF YES, ADMISSION FEE: $________
WILL YOU BE SERVING NON-CATERED REFRESHMENTS/FOOD? |  |  |  |  |  |  |  | YES |  | NO
CATERED FOOD SERVICE? |  |  |  |  | YES |  | NO
CATERED ALCOHOL SERVICE? |  |  |  |  | YES |  | NO
NOTE: ALL ALCOHOL MUST BE PROVIDED BY A LICENSED AND INSURED PROVIDER: "BRING YOUR OWN BOTTLE" IS STRICTLY PROHIBITED. PLEASE ASK FOR A CURRENT LIST OF CIVIC CENTER PARTICIPATING CATERERS.
ANTICIPATED NEEDS: |  |  |  |  | AUDIO/VISUAL: |  |  |  | CIVIC CENTER COFFEE SERVICE:
 | TICKET TABLE (OUTSIDE ROOM) |  |  |  | MULTI-MEDIA PROJECTOR |  |  |  | (COFFEE, TEA, ALL SUPPLIES)
 | LECTERN WITH MICROPHONE |  |  |  | SCREEN |  |  |  | 12 CUP COFFEE SERVICE
 | MICROPHONE ON STAND |  |  |  | IPOD/COMPUTER TO HOUSE |  |  |  | 30 CUP COFFEE SERVICE
 | PORTABLE STAGE |  |  |  | DRY ERASE BOARD W/MARKERS |  |  |  | 55 CUP COFFEE SERVICE
 | DANCE FLOOR |  |  |  | FLIP CHART W/MARKERS |  |  |  | ICE WATER SERVICE
 | DECORATIVE LIGHTING |  |  |  | [NAME] |  |  |  | OTHER
The Valdez Civic Center had a wide array of equipment in addition to what is listed here. Please call for more information.
ROOM SET UP STYLE:
 | HEAD TABLE FOR ____ |  |  |  |  | U-SHAPED |  |  |  | RECTANGLE/SQUARE
 | THEATRE STYLE (ROWS OF CHAIRS) |  |  |  |  | CONFERENCE STYLE |  |  |  | BANQUET STYLE
 | SEMINAR/CLASSROOM |  |  |  |  | SEMINAR @ OVALS |  |  |  | OTHER
The Valdez Civic Center Staff will contact you prior to your event for final details.
Applicant hereby represents that he/she has made a full and complete disclosure of all information which might be pertinent to the  [NAME] consideration of this application and that all of the foregoing statements and information are true and correct.  Applicant must comply with all current Civic Center policies and all applicable local, state or federal laws regarding licensing, bonding, copyright protection or other requirements.  Applicant accepts responsibility for payment of rental, equipment and services fees and for restitution of any damage to the facility or equipment resulting from Applicants use of the Civic Center.
I hereby acknowledge that I have read, understand and agree to abide by all the polices governing the use of the Valdez Convention and [NAME] as stated on pages 2 and 3 of this Application and Conditions for Use.
CLIENT SIGNATURE |  |  |  |  |  |  | DATE
CIVIC CENTER APPROVAL: |  |  |  |  |  |  | DATE: