Attachment IV

 

ALCOHOLIC BEVERAGE ACTIVITY

 

(Print) Name of Person Making Request____________________________________________________

 

Texas State ID#____________________________††††††††††††††††††††††† Date____________________________

 

If you are a university employee, please provide:

 

Name of Office/Department: ________________________________ E-mail _______________________

Phone ______________________ Is this a university sponsored event? ___Yes†† ____No

 

 

If you are not a university employee please provide:

E-mail _____________________________ Phone__________________________

 

Address_________________________________________________††††††††† Phone____________________

 

TYPE OF ACTIVITY

 

____________†† Departmental††††††††††††††††††††††††††† ____________†† Closed Social††††††††††††††

____________†† Student Organization†††††††††††††††† ____________†† Free __$______ Charge

____________†† Residence Hall††††††††††††††††††††††††† ____________†† Open (ALL CAMPUS) Social

____________†† Other (Specify)††††††††††††††††††††††††† ____________†† Free _$_______ Charge

 

Type of Alcoholic Beverages to be made available: ___________________________________________

Type of Non-Alcoholic Beverages to be made available: _______________________________________

 

DESCRIPTION OF EVENT_________________________________________________________________

 

DATE 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 persons 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 or rule or regulation of the university. Furthermore the undersigned agrees to reimburse the university for any loss, damage, or expense incurred by the university as a result of the undersignedís use of the facility, and is aware the university will not assume any liability for property damage or personal injury including death, that may result from or during the undersignedís use of the facility. 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 and possess a current and valid certification to dispense alcohol. Police officers must be present unless an exception is granted by the university.

 

 


 

Signature of Organization President:††††††††††††††††††††††††††††† ________________________________________________†††††††††††

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Print_________________________ Date_______________††††††††††

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

Signature of Sponsor:†††††††††††††††††††††††††††††††††††††††††††††††††† ________________________________________________††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Print_________________________ Date_______________

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

Signature of University Police Director/Designee: ††††††††† ________________________________________________††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Print_________________________ Date_______________

 

Number of Officers Assigned ______

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

Signature of Facility Director/Coordinator:††††††††††††††††††††† ________________________________________________††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Print_________________________ Date_______________

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

Signature of Representative of

Company Contracted to Serve Alcohol:††††††††††††††††††††††††† ________________________________________________ ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Print_________________________ Date_______________††††††††††

 

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

Signature of Dean of Students/Designee:†††††††††††††††††††††† ________________________________________________†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Print_________________________ Date_______________††††††††††

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††