MOSAIC Room Reservation Form

MOSAIC Room Reservation Form
Demographic Information - tell us a little about who you are!

* Required
Event Title*
Event Date*

MonthDayYear
Event Duration - Start and End Time
Please consider setup and breakdown time when setting event duration.
Start Time *

Hour Minutes

AM/PM Option
End Time *

Hour Minutes

AM/PM Option
Event Description *
Expected Attendance*
Requested By
Name*

First NameLast Name
E-mail*
Phone Number*
Department/Organization *
Contact Person *
Which of our spaces will you require? Check all that apply.*

Living RoomKitchenIntern OfficeDownstairs LibraryBasement Lounge
Event Needs (If you need assistance utilizing any of these services, please schedule time to meet with MOSAIC staff)

ProjectorSound SystemTelevision ScreenSodexo ServiceOther
Terms of Use
If you need assistance utilizing the projector, screen, TV please arrange time to meet with the director

All visitors reserving space in the Muhlenberg College Office Student Access Inclusiveness Community must adhere to the following:
1. Wash all dishes, pots, pans used
2. If dishwasher is full of CLEAN dishes - empty and reload
3. Wipe countertops
4. Remove trash to dumpsters out back
5. Call campus safety at x3100 to relock doors to the Center
6. Return any moved furniture to its original location
Failure to follow these terms may result in your reservation privileges being revoked.
Please initial and date to confirm that you have read this form in its entirety and agree to comply with terms of use. *
Date Recorded

MonthDayYear
Enter the message as it's shown*
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MOSAIC Room Reservation Form

Event Duration - Start and End Time

Requested By

Terms of Use