Date: Month/ Date / Year

Date: Month/ Date / Year

RIKUZENTAKATA GLOBAL CAMPUS

Rental SpaceReservation Form

MontyDickson Hall / Meeting Room/Multipurpose Room/ Workshop Room /

Tatami Room/ Lecture Room

Applicant Name#
Applicant’s Organization Name#
Contact Information / E-Mail Address :
Phone Number :
Supporting Member Information
(Please circle) / Supporting Member:Individual Student Organization/Corporation
Non-Supporting Member:
□I would like to be Supporting Member
→Individual Student Organization/Corporation
Iwate University Official Rikkyo University Official
Rikuzentakata City Official
Rental Space Purpose( or Event Title )#
*Date/s # / From Month / Date / Yearto Month / Date / Year
* Timings #
(Circle :multiple selection allowed ) / 9:00-13:00 13:00-17:00 17:00-21:00
9:00-17:00 13:00-21:00 Full day
Room/s and/or Facilities #
(Circle :multiple selection allowed ) / MontyDickson Hall Meeting Room 1 Meeting Room 2
Multipurpose Room 1 Multipurpose Room 2
Workshop Room Tatami Room 1 Tatami Room 2
Lecture Room Gym Large Kitchen Room
Number of Participants (approx.)
Device/s
(Circle :multiple selection allowed ) / Wireless Microphone/ Amplifier Projector
Projector screen
Car Parking / Required (Number of Spaces: ) Not Required
Additional Requests

(1) Information for the items with the mark # may become available to the public on the Rikuzentakata Global Campus website.

(2) For multiple reservations, please use the Multiple Reservation Form, and send it with this form by email or fax.

(3) Please contact to the Reception (Office) when you should make changes to the reservation.

(continued overleaf)

Open to Public?# / Yes, without reservation Yes, with reservation
Possibility of visits No
Short Message for intoroducing the event for the public #

(4) Please attach the poster or flyerof the event to the e-mail If you wish to upload it on the website of RTGC.

RIKUZENTAKATA GLOBAL CAMPUS

Multiple Reservation Form

Applicant Name

Room and/or Facilities
Monty’Dickson Hall / Meeting Room 1/ Meeting Room 2 / Multipurpose Room 1 / Multipurpose Room 2 / Workshop Room / Tatami Room 1 / Tatami Room 2 / Lecture Room / Gym /Large Kitchen Room / Dates / Timings
A :9:00～13:00B :13:00～17:00
C :17:00～21:00D :9:00～17:00
E :13:00～21:00F :All day
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