Alcohol Request Form

Date:     
Event Title:
Location: 
If "Other" type in location:

Start Time of Event:

  (Must be after 5:00 p.m.)
End Time of Event:  
Event Participants: Staff       Visitors   Patients
Will Minors Be Attending? Yes No
Alcohol Service Required: Wine      Beer       Hard Liquor

House Alcohol:  Burgundy (carafe), Chablis (carafe), Sycamore Lane Chardonnay, Sycamore Lane Cabernet Sauvignon, Michelob, Michelob Light, Christian Brothers Brandy, Paramount Gin, Popov Vodka, Ten High Kentucky Bourbon, Landers Scotch

 

Special Request alcohol may be available, however, orders must be placed a minimum of three weeks in advance.  Orders placed after this time are not guaranteed and may carry an additional fee.

  • We reserve the right to refuse alcohol service to any individual or group.
Contact Information:  
  Name:  
  Department:
  Phone Number:
  Campus Address:
  e-mail address:
Questions or Comments:

Please print out this form and send to Linda Spence, HHR, C110 GH.