Facility Rental Form-14-15 - Frederick Douglass Resource Center

FACILITY RENTAL QUESTIONNAIRE
2014-2015
THIS QUESTIONNAIRE MUST BE RETURNED
PRIOR TO THE DATE OF YOUR EVENT.
NO PUBLICITY, TICKET PURCHASING, OR “ON SALE” PARAPHERNALIA
SHOULD BE DISTRIBUTED PRIOR TO THIS AGREEMENT BEING RETURNED.
For Office Use only
Event Coordinator:_______________________________
Date:___________________________________________
FREDERICK DOUGLASS RESOURCE CENTER
FACILITY RENTAL QUESTIONNAIRE
Event Name: ______________________________________________________________
Event Space(s) Requested: ___________________________________________________
Date of Event: _____/_____/_____ Event Start Time: ______ Event End Time: ______
Organization: _____________________________________________________________
Contact Number: ______-______-______
Fax Number: ______-______-______
Organization Address: ______________________________________________________
_________________________________________________________________________
Primary Contact: __________________________________________________________
Primary Contact Telephone: ______-______-______
E-mail: __________________
Charges will be assessed for services according to Lic e ns i ng Sc hedul e Rates set by
Th e FDR C.
This Fa c i li t y Rental Questionnaire must be signed by an authorized
representative of The FDRC in order to initiate a venue rental / licensing agreement.
To ensure the success of your event, please complete the questionnaire to the fullest
extent possible at this time. If additions, deletions, or changes become necessary, please
immediately contact The Frederick Douglass Resource Center’s Program Director. You can
reach us at (585) 497-6139 or via email at [email protected]
Has your organization previously held an event at The FDRC?
YES _____
NO _____
If YES, Date of Event: _____/_____/_____ Name of Event: ________________________
Admissions:
General: _____
Free: _____
Reserved Seating: _____
Ticketing Rates:
Adult: _____ Students: _____ Children: _____ Seniors: _____ Group(s): _____
Please indicate if any discounted rates will be offered.
Will you use a ticketing outlet?
What is your projected “On-Sale” date: _____/_____/_____
Please provide a brief description of your event:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
“YOUR” EVENT MANAGEMENT
Event Duration:
Approximate Length of Event: ________________________________________________
Seating:
What is your plan for coordinating seating AND has Security been considered?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
* Arrangements may be made with The FDRC to provide seating assistance for an additional
fee. Unless special arrangements are made, The FDRC will not be responsible to coordinate
seating. The FDRC will however, follow our ‘Objectionable Patrons’ clause. (See section III
of the “Letter of Agreement And Facilities Use Policies And Procedures” information
package).
TECHNICAL SERVICES
SCHEDULE:
Please attach a separate and detailed list describing the program itinerary.
IMPORTANT: Please attach a copy of the artist’s technical rider. (If applicable)
A contract will not be released until the contract rider and proof of insurance have been
presented. Otherwise, your organization will hold The FDRC harmless in the event of any loss
or damage(s) to the belongings either yourself, your program participants OR guest presenters.
EVENT DATE(S): ______/______/______ - ______/______/______
EVENT START TIME: ______
EVENT END TIME: ______
Rehearsal Needs: (how much time is required for set up and break-down?)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Program Needs: (how much time is required for set up and break-down?)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Load-In / Set-Up Needs: (how much time is required for set up and break-down?)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Merchandising:
* For outside vendor participation, a $25 merchandising may be collected by The Frederick
Douglass Resource Center prior to your event. At this time, unless special arrangements are
made, the maximum number of Vendors (if applicable) allowed is two (2) per event.
EQUIPMENT NEEDS:
* Sound/Lighting/Projection (Indicate YES or NO and Quantity – all equipment is subject to
availability)
Item
Yes / No
Qty.
Item
Yes/No
Qty.
Microphone(s)
CD Player
Video Projector
Video Recording
General Lighting
Lectern
Tables
___/___
___/___
___/___
___/___
___/___
___/___
___/___
____
____
____
____
N/A
____
____
Cassette Tape Deck
House Sound System
Slide Projector
Audio Recording
Special Lighting
Chairs
Easel(s)
___/___
___/___
___/___
___/___
___/___
___/___
___/___
____
N/A
____
____
____
____
____
Other Needs not indicated above:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_________________________________________________________________________
By completing this questionnaire, the user acknowledges, by signing below, receipt of a copy of
The FDRC Facility Rental Questionnaire and agrees to be bound by and adhere to the general
guidelines therein.
Organization’s Authorized Representative Signature and title:
____________________________________ ____________________________________
Name
Title
FDRC Authorized Signature and title:
____________________________________ ____________________________________
Name
Title
Date: ______/______/______
Frederick Douglass Resource Center
Licensing Fee Schedule - 2014-2015
Pitts Hall
Capacity
GBF Gallery
Reception
200
Theater
130
Energy East Computer Lab
Rush Resource Library
Computer Lab
12 - 24
Classroom
25
* based on block of time
* based on block of time
* based on block of time
125.00
200.00
300.00
400.00
500.00
N/A
N/A
* based on block of time
* based on block of time
* based on block of time
35.00****
50.00
100.00
125.00
150.00
N/A
N/A
Banquet
130
Space
Priority I
Priority II
Priority III
1 Hour Block
2 Hour Block
4 Hour Block
6 Hour Block
Daily Rate
Auxiliary Area
** Rehearsal Fee
* based on block of time
* based on block of time
* based on block of time
175.00
275.00
375.00
475.00
650.00
25.00
50.00
Production Manager
*** Production Coordinator
*** Sound Engineer
*** Lighting Engineer
*** Materials Crew
150.00
125.00
100.00
50.00
75.00
* based on block of time
* based on block of time
* based on block of time
250.00
150.00
200.00
375.00
300.00
475.00
400.00
575.00
25.00
N/A
Technicians (Daily Rates - per day/per person @ 8 hours)
150.00
125.00
100.00
50.00
100.00
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
25.00
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
$100
$50
$75
$100
15.00
25.00
N/A
N/A
N/A
5.00
N/A
N/A
N/A
N/A
N/A
N/A
N/A
5.00
15.00
25.00
5.00
N/A
1.00
5.00
N/A
10.00
7.50
5.50
N/A
2.50
1.00
5.00
Front of House Staffing
Ushers
Usher Coordinator
Event Staff
Security Personnel
$10 per hour
$12 per hour
$14 per hour
$25 per hour
$10 per hour
$12 per hour
$14 per hour
$25 per hour
House Services
Merchandising Fee
Food Service Clean-Up
Flat Rate Housekeeping
$25
N/A
$50
$25
$100
$100
15.00
50.00
5.00
10.00
1.00
5.00
N/A
2.00
2.00
10.00
5.00
5.00
1.00
5.00
15.00
50.00
5.00
10.00
1.00
5.00
1.50
2.00
2.00
10.00
5.00
5.00
1.00
5.00
Equipment
DVD / CD / Cassette Player
Digital Video System
Microphone (wired)
Wireless Microphone (s)
Microphone Stand
Extra Lectern
Chairs
6' Table
8' Table
Table Skirting
Spot Lighting
Easel
Column
Pedestal
Licensure of space is based on Priority scheduling
*
** Rehearsals are limited to two (2) hours & do not include use of house equipment
*** Services provided if requested
**** Priority Community Scheduling Fees May Vary

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