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Event Reservation Form Potomac Science Center
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Organization
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Name of company or business if applicable
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
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Western Sahara
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Zambia
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6
Type of Organization
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Profit
Nonprofit
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7
Title of Event
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8
Preferred Event Date
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-
Date
Year
Month
Day
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9
Event End Date
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Date
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10
Event Start Time
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Hour
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Event End Time
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12
Expected Attendance
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13
Preferred Location
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Lecture Hall 1205, standard set up-classroom style, seats 36, flexible set up options
Multipurpose Room 1006, standard set up-round tables, seats 96, flexible set up options
Conference Room 1207, standard set up-conference square, seats up to 10
Exhibition Gallery Space River Level, flexible set up, standing capacity 86
Pre-Function Lobby, flexible set up, standing capacity 197
Outdoor spaces
Not sure
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14
What is your desired room set up
Seated Rounds
Classroom Style
Theater Style
Hollow Square
U-Shape
Reception
Clusters/Work Groups
Other
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15
Event Description
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Tell us about your event
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16
Target Audience
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17
Timeline of Activities/Event Agenda
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18
Timeline of Activities/Event Agenda
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19
What resources are required, if known?
e.g., projector, laptop, table mics, wireless mics, guest wifi, video conferencing
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20
Is the event involving any VIPs (ambassadors, politicians, etc), key speakers, or a major performance?
Yes
No
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21
If yes, who will be attending?
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22
How many parking spaces are required for this event?
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23
Will there be food at the event?
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Food served at events must be prepared by a licensed and insured caterer. Approved caterers, including the university’s caterer, are listed at http://approvedcatering.gmu.edu/approvedcaterers.html If your caterer is not on the approved list, follow the instructions to have them approved.
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No
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24
Will there be alcohol at the event?
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Note: Events with alcohol are required to have Mason police present. Your event coordinator will assist you in making these arrangements
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No
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25
Will Sodexo (George Mason's caterer) be catering the event?
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Yes
No
Not Sure
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26
If not, please indicate the food provider?
Please review Mason's approved caterers list at https://shopmason.gmu.edu/catering/list/
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27
The insurance requirements are as follows:
Commercial General Liability in an amount no less than $1M per occurrence with a $2M aggregate If minors are present, Sexual Abuse and Molestation in the amount of no less than $1M with a $2M aggregate If you will be driving people around on campus for the event, Commercial Automobile Liability in the amount not less than $1M per occurrence Workers Compensation in an amount not less than that prescribed by statutory limits AND an Umbrella/Excess policy in an amount not less than $1M to apply OVER and ABOVE the above insurances. At all times during this Agreement Client shall maintain the following insurance coverage: Commercial General Liability in an amount not less than $1,000,000 per occurrence with a $2,000,000 aggregate; We realize, many of our clients do not have formal event insurance with their companies. In order to assist we have partnered with TULIP (SPECIAL EVENT INSURANCE). You can visit this site to get an insurance quote based on your event. http://risk.gmu.edu/insurance/tulip-special-event-insurance/ We encourage all clients, to find out the costs of the insurance prior to going to contract. Once a contract is signed, the insurance is due within 30 business days, and no later than 30 business days of the event. Failure to provide the insurance, is a breach of the contract – thus canceling the event. If this happens, no deposits are refundable
I have insurance
I need insurance
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