Facility Use Application

Kimmel Education and Research Center 5985 G Road, Nebraska City, Nebraska 68410 Facility Use Application

1. Name of Business: 2. Type of Event: 3. Date of Use: Time: 4. Estimated Number of Participants: 5. Contact Person: Email: Address: 6. Phone: Will food be served? Yes No (Note: For a list of available licensed caterers in the area are on our web page under “Conference Room”) 7. Is general public invited? Yes No 8. Is a fee being charged for the event? Yes No 9. Do vendors or participants have booths to set up? Yes No

Requested Equipment: (Identify your equipment needs with an X) Microphones Podium of Technology (Computer, VCR, DVD, LCD Projector & Screen) 30 Cup Coffee Pots (3 available, you must bring your own coffee supplies) 50 Cup Cold Beverage Server (2 available, you must bring your own ice & supplies)

Set up Styles Available: *** Conference Room can be divided into 1, 2, or 3 meeting spaces*** Classroom U-shape Tables in”O” Pods Chairs Only

SEATING CAPACITY SEATING CAPACITY SEATING CAPACITY SEATING CAPACITY SEATING CAPACITY UP TO 70 UP TO 36 UP TO 46 UP TO 8 PODS UP TO 100 Conference Room Use Fees: (Identify your business structure with an X) For- Profit $200 Non-Profit $175 Extension $135

Holding Reservation Deposit: The user must submit a ”Holding Reservation Deposit” of $75.00. Upon payment the user will be placed on the facility use calendar. This deposit will be applied toward the rental fee and is refundable upon written notification of cancelation at least 60 days prior to event. SUBMIT THIS FORM BY EMAIL TO - [email protected] or fax to 402-873-3218