New Submission

Submitterfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Prior Submissionfield type checkbox
Prior SubmissionYes
Prior Submission Stage*field type drop-down
What stage does the form need to be at
FromEmailAddressfield type email

Non-Discrimination and Accessibility Statement

Please click here to read the Linn-Benton Community College Equal Opportunity/Statement of Nondiscrimination policy
By checking this box I acknowledge the following*field type checkbox
By checking this box I acknowledge the followingI have read and understand the above Linn-Benton Community College Equal Opportunity/Statement of Nondiscrimination policy.
Does this event require ADA accomodations?*field type radio button
Does this event require ADA accomodations?YesNo
Please provide additional information:*field type multi line

Board Policy & Administrative Rules

User is responsible to supervise and maintain the health, safety, and care of personal property, User employees, and participants while they are on college property. User shall ensure compliance with all federal and state laws and statutes as well as LBCC Board Polices and Administrative Rules governing facility use and conduct of visitors on campus. See Board Policies and Administrative Rules - especially BP 5045, BP 5050, BP 5055, BP 5060, BP 5095.
By checking this box I acknowledge the following*field type checkbox
By checking this box I acknowledge the followingI have read and understand the above Board Policies and Administrative Rules.

Liability Insurance Information

I am requesting space for a group or club*field type radio button
I am requesting space for a group or clubFrom within Linn-Benton Community CollegeFrom outside Linn-Benton Community College
Will there be vendors at this event?*field type radio button
Will there be vendors at this event?YesNo

Vendor Information

	Vendor Namefield type single line	Emailfield type email	Phone Numberfield type single line
Row 1×	Vendor Namefield type single line Input blocked. Maximum character limit of 4000 characters reached.	Emailfield type email	Phone Numberfield type single line Input blocked. Maximum character limit of 4000 characters reached.	×

Add

Insurance information may be required for vendors.
Xfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Is your group registered as a Non-Profit Agency?*field type radio button
Is your group registered as a Non-Profit Agency?YesNo
Please upload your 501(c)(3) documentation here (pdf only)*field type file upload
Drop files here
You have reached the maximum file limit: .
Do you have liability insurance?*field type radio button
Do you have liability insurance?Yes, I will upload it into this formYes, I will email it in at a later timeNo, I would like to request a waiver
Please explain the reason why a waiver is needed*field type multi line
Certificate of Insurance (pdf only)*field type file upload
Please upload your liability insurance documentation here
Drop files here
You have reached the maximum file limit: .
Linn-Benton Community requires liability insurance coverages for outside parties to use, lease, or rent our facility spaces. With 2 million in liability coverage and Linn Benton Community College listed as additionally insured. Until such time as your organization is able to provide such insurance or a written request (above) for a waiver, we will be unable to proceed with your request.
Instructions on where to email this will be sent to you after you submit this request. LBCC must have a copy of your insurance on hand in order to fully process your event request.

Waiver

User Self-Insurance Agreement

User hereby agrees to fulfill the insurance requirements contained in paragraph 2(e) of the Facility Use Agreement under a plan of self-insurance. Accordingly, the College agrees to release the User from the requirements contained in paragraph 2(e) of the Facility Use Agreement. The User shall only be permitted to utilize such self-insurance if in the opinion of the College and based on the User’s representation, the User’s (i) net worth, and (ii) reserves for payment of claims of liability against the User, are sufficient to adequately compensate for the lack of other insurance coverage required by the Facility Use Agreement. User’s utilization of self-insurance shall not in any way limit liabilities assumed by User under the Facility Use Agreement. Except for paragraph 2(e), the User hereby agrees to be bound by all remaining terms of the Facility Use Agreement.
Signature*field type signature
Datefield type date
Date will be captured on form submission

Event Details

This event is a*field type drop-down
Event Name*field type single line
Input blocked. Maximum character limit of 80 characters reached.
Please add a description of the event you wish to have*field type multi line
Does this event include activities where there is any risk of injury to person(s) or damage to property*field type radio button
Does this event include activities where there is any risk of injury to person(s) or damage to propertyYesNo
Please describe the activity that is creating this risk*field type multi line

Requestor Information

Organizations Name*field type single line
Input blocked. Maximum character limit of 60 characters reached.
Requestor First Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Requestor Last Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Email Address*field type email
Verify Email Address*field type email
Contact Phone Number*field type single line
Please enter the best number to contact you at M-F 9 am - 3 pm
Input blocked. Maximum character limit of 4000 characters reached.
Organizations Phonefield type single line
If different than contact phone
Input blocked. Maximum character limit of 4000 characters reached.
Address*field type address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Name of Contact with Contract Signing Authority*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Email Address for Contact with Contract Signing Authority*field type email
Verify Email Address for Contact with Contract Signing Authority*field type email

Reservation Information

Click here for a view of our campuses spaces with maps
**Please click here for our Facility Use Fee Schedule for estimated costs. Prices listed are approximate. Final charge may differ based on specific usage or requests. Reduced rates will be applied for non-profit and internal customers.
Location Descriptionfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Location I am requesting the reservation for*field type radio button
Location I am requesting the reservation forAdvanced Transportation Technology Center (Lebanon)Albany Athletic CenterAlbany CampusCorvallis CampusHealthcare Occupations Center (Lebanon)Lebanon Center (Lebanon)
Number of Attendees Expected*field type number
Event Dates*field type radio button
Event DatesChecking on availability-event dates are flexible and I need to know which work bestEvent date(s) cannot be changed

Event Date(s)

	Start Datefield type date	Start Timefield type time	End Datefield type date	End TImefield type time	Day Priorfield type date	DaysOutfield type number
Row 1×	Start Datefield type date	Start Timefield type time	End Datefield type date	End TImefield type time	Day Priorfield type date This field contains a calculation error. References: Event Date(s) Start Date	DaysOutfield type number This field contains a calculation error. References: Submission Date, Event Date(s) Start Date	×

Add

Earliest Event in _ Daysfield type number
BC: Benton Center CH: Chinook Hall

Room(s) Requested

	Room Type*field type drop-down	Room Name*field type drop-down	Internal Room Name*field type drop-down	Seating Capacityfield type single line	Roomfield type single line	How many courts*(?)field type drop-down	How many courts*(?)field type drop-down	Room Assigned*field type single line
Row 1×	Room Type*field type drop-down	Room Name*field type drop-down	Internal Room Name*field type drop-down	Seating Capacityfield type single line Input blocked. Maximum character limit of 4000 characters reached.	Roomfield type single line Input blocked. Maximum character limit of 4000 characters reached.	How many courts*(?)field type drop-down	How many courts*(?)field type drop-down	Room Assigned*field type single line Input blocked. Maximum character limit of 4000 characters reached.	×

Add another room

Preferred Room:field type single line
(please fill in building and room number ONLY if you have one that is specifically preferred) list up to 3
Input blocked. Maximum character limit of 4000 characters reached.
Review to be completed byfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
ReviewerLFIDfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
ReviewerEmailfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Special Notes to Event Coordinatorfield type multi line
Facilities is not able to arrange or restore a room to specifications. If you have questions regarding this please contact Facilities at extension 4721. Thank you
EMS: https://linnbenton.emscloudservice.com/web/BrowseForSpace.aspx
I reviewed EMS and this space is available during the requested timefield type radio button
I reviewed EMS and this space is available during the requested timeYesNo
Optional Room arrangement:field type radio button
Only applicable to Classrooms, Conference Rooms and Banquet Rooms
Optional Room arrangement:Classroom styleClassroom-ChevronGroupsLecture (lectern and chairs only)SquareSpecial Instructions
Click here for room arrangement diagrams
Special Instructions for room set upfield type multi line
Will you be the onsite contact at the event?*field type radio button
Will you be the onsite contact at the event?YesNo
Name of contact at event*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Phone number for contact at event*field type single line
Input blocked. Maximum character limit of 4000 characters reached.

Food Options

AR-5045-01,BP 5060
Will food or beverages be provided at this event?*field type drop-down
Please refer to AR 5045-01 for catering and vendor informationhttps://www.linnbenton.edu/about-lbcc/administration/policies/board-policies-and-administrative-rules/5000-series-finance-and-operations/ar-5045-01.php
Do you plan on serving alcohol at this event?*field type drop-down
If yes, please review our BP 5060, regarding alcohol. Additional paperwork will be required.https://www.linnbenton.edu/about-lbcc/administration/policies/board-policies-and-administrative-rules/5000-series-finance-and-operations/bp-5060.php
Would you like LBCC Culinary to provide food and/or beverage service for this event?*field type drop-down
Please describe culinary needs below*field type multi line
Linensfield type checkbox
LinensLinen TableclothsCloth NapkinsNone

Furnishing/Equipment for Event

Please Select All Furnishings Requestedfield type checkbox
Please Select All Furnishings RequestedScreen LiftOregon FlagU.S. FlagCoat Rack(s)PodiumDesk PodiumRoom DividerStage (6'x 8')
How many coat racks will you need?*field type number
Maximum 5
How many pieces of a stage do you need?*field type number
Minimum 2 / Maximum 4
Please Select Media Equipment Requestedfield type checkbox
Please Select Media Equipment RequestedPortable PAPodium MicrophoneWireless MicrophoneFlat MicrophoneDocument Camera (ELMO)DVD PlayerCamcorderDigital CameraVideo ProjectorLaptop ComputerMulti-Media Cart10' x 10' Screen
Will you require Media Tech Support during your event?*field type radio button
Will you require Media Tech Support during your event?YesNo
Media Tech Support will be provided by an LBCC employee. There may be an additional charge for this service.
Additional Notes for the LBCC Event Coordinatorfield type multi line
There will be a deposit of 50% of the estimated cost. Please see AR 5045-01 Section F for our cancellation policy.
Submission Datefield type date
Date will be captured on form submission
RequestYearfield type single line
Input blocked. Maximum character limit of 4000 characters reached.

Initial Review Section

Event Date(s)*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Event Year (4 digit)*field type single line
Input blocked. Maximum character limit of 4000 characters reached.

2nd Review

Confirmed Event Start Date*field type date
Confirmed Event End Date*field type date
Event Start-End Time*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Additional Information Boxfield type multi line

Quote

Facility Rental Albanyfield type currency
FREN 21445 5420 07130 95065$
Athletics Rental Albanyfield type currency
AREN 21445 5420 07130 95065$
ATTC Rentalfield type currency
ATRE$
Facility Rental Chinook Hallfield type currency
CREN 21417 4226 01730 95065$
Facility Rental Benton Centerfield type currency
BREN 26420 4226 01730 95065$
Facility Rental Lebanon Centerfield type currency
LREN 21414 4234 01730 95065$
Facility Rental HOCfield type currency
HREN$
Parking Lot Rentalfield type currency
PRKL$
Custodialfield type currency
ECUS 25640 5510 07130 95065$
Event Public Safetyfield type currency
EVPS$
Media Equipmentfield type currency
MEQP 21422 4373 01740 95065$
Event Miscfield type currency
(example: linens): EVMS 21445 5420 07600 95065$
Total Estimated Chargesfield type currency
$
Total Deposit Requiredfield type currency
$

Response To Quote

Response to Quote*field type radio button
Response to QuoteReceivedCustomer DeclinedNot Received

Facility Use Agreement

Please upload agreement*field type file upload
Drop files here
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Deposit Receipt

Attach Receipt*field type file upload
Drop files here
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VendorID*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Amount Received*field type currency
$

LBCC Facility Use Request Form

Non-Discrimination and Accessibility Statement

Board Policy & Administrative Rules

Liability Insurance Information

Event Details

Requestor Information

Reservation Information

Event Date(s)

Room(s) Requested

Food Options

Furnishing/Equipment for Event