Attachment IV

 

ALCOHOLIC BEVERAGE ACTIVITY

 

Name of Organization______________________________________ Date_________________

 

Person Making Request_____________________________________ ID#__________________

 

Address__________________________________________________ Phone________________

 

TYPE OF ACTIVITY

 

____________ Departmental ____________ Closed Social

____________ Student Organization ____________ Free ________ Charge

____________ Residence Hall ____________ Open (ALL CAMPUS) Social

____________ Other ____________ Free ________ Charge

 

Type of Beverage__________________________________________

 

DESCRIPTION OF EVENT_______________________________________________________________

 

DATE (S) OF EVENT__________________________ TIME ___________ AM/PM__________ AM/PM

 

LOCATION_________________________________________ ROOM ASSIGNED__________________

 

ANTICIPATED ATTENDANCE___________________________________________________________

 

The undersigned, in connection with the application to reserve a facility for the event described, certifies that (1) such function will not be restricted on the basis of race, religion, sex or national origin, (2) such function will normally be restricted to university related groups, (3) appropriate person s will be present at the function to insure the proper use of the facility, (4) such function and use of the facility will not violate any law of the state, rule or regulation of the university. Furthermore the undersigned agrees to (a) reimburse the university for any loss, damage, or expense, and (b) is aware the university will not assume any liability. Beverage servers must be present at all events in which alcohol is served and must be seller or server trained through a certified TABC School to dispense alcohol. Police officers must be present unless an exception is granted by the University Police Director or designee.

 

 

Signature of Organization President Date

 

 

Signature of Sponsor Date

 

 

 

University Police Director/Designee Officers Assigned (No.) Date

 

 

Facility Director/Coordinator Date

 

 

Food Service/Alcoholic Beverage Contractor Date

 

 

Dean of Students/Designee Date