Facility Use Form

Name of Person or Group requesting use (responsible party, billing information); If a student organization the form must be signed by BOTH the faculty/staff advisor and the student group president and must be approved of prior to scheduling room use. Final approval is required by a Vice President before request is scheduled.

Return completed form to Poplar Campus or Wolf Point Campus two (2) weeks prior to event.

Phone *

Billing Address *

City/State/Zip *

Today's Date *

Rental Type *PersonalOrganization

If organization, include name:

Date of Function *

Time of Function *

Purpose for Request *

# of People Expected *

Building Requested

Electronic Signature *
By checking this box I affirm that all information submitted is true and correct. This serves as my electronic signature for this application.

WARNING: Failure to clean up after your event, tampering with electrical systems to include building breaker boxes such as fire/smoke alarms, furnace pilot lights, and security systems could affect future use of college facilities.

Disclaimer

FPCC is not responsible for accidents, thefts, injuries or other criminal activity, which may occur during the proposed use of the facilities described on this form.

PAYMENT MUST BE PAID IN FULL PRIOR TO USAGE OF ANY FPCC BUILDING. FPCC RESERVES THE RIGHT TO REFUSE OR DENY THE USE OF ANY FACILITY.

Monday – Friday
$125.00

Friday Evening – Sunday
$250.00

Make all checks payable to: Fort Peck Community College

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