Campus Activities Request

Organization*

Name of Event*

Proposed Date*

Time*

: HH

MM

End Time*

: HH

MM

President*

Contact Number*

Organization Advisor*

Advisor Contact Number*

Organization Co-Advisor

Co-Advisor Contact Number

Email*

Enter Email Confirm Email

Activity Details

Type of Activity

Other (Please Specify)*

Cost of Admission*

Name of Insurance Company

Policy Number

Agent Name

Telephone Number

Requested Location*

I understand and agree to abide by all Wilberforce University regulations and Ohio State laws in the staging of this activity.*