Central Michigan University Police Department

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Special Events Form

EVENT INFORMATION

Event Name
Event Date
Event Location (Building)

PARKING INFORMATION

Lot Number
Number of Spaces Needed
Start Time
End Time

SPECIAL REQUEST (PARKING SERVICES APPROVAL REQUIRED)

Lot #
Reserve Meters (cover)	Yes No
# of Meters to cover
Reserve Lot (barricade)	Yes No

CONTACT INFORMATION (Required fields are marked with asterisk *)

Department Name*
Contact Person*
CMU Dept. address*
Phones	# 1* #2
Email address*
Account #	CMU Other

BILLING INFORMATION

__________Officer(s)/student(s) for____________hours each at $43.96 per hr equals $___________________ ________Student employee(s) for_____________hours each at $9.00/hour equals $ other fee(s) (specify) at $__________________ Total amount billed $_______________

Signature Date

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