Home » Alumni and Foundation » Alumni Association » Simmons Room Reservation Form


·       Room availability should be cleared through the Alumni-Foundation office before submitting this form.

·       Arrangements for Food Service, and Audio-Visual equipment must be made with the appropriate departments).

·       All arrangements should be made and this form completed at least fourteen (14) days prior to your event.

·       Your activity will not be placed on the University Calendar until the event has been approved by all appropriate University officials.

·       To submit a paper request, print this form and return completed  form to the Alumni-Foundation Office, Box 3104. 


Detailed Event Information
Name of Event:    Sponsored By:
Campus Location:   
Date of Event(s):     Start Time:      End Time:

Estimated Attendance:

                    Private Event?    YES  NO 
Tickets, Conference/Seminar Fees – Charge For Events
Additional Information:
Facility Setup/Placement
Click here to see an example of each style.  

Table Type:

Head Table? YES   NO       If yes, how many seats?

Podium?       YES   NO       If, yes, WITH MICROPHONE   or WITHOUT MICROPHONE


Technology, Food Services, Housing

Audio-Visual Equipment?

YES    NO   

Click here to reserve AV equipment or contact OIT at 662.846.4760

Food Services?

YES    NO   

Contact the Catering Manager at 662.846.4416 to make arrangements.

Contact Information
Name:      Phone:    Email:
Address Information: Mailing:    City:    State:   Zip:
University Affiliation    
Terms of Agreement

I agree to be personally responsible and liable for the welfare and safety of equipment and facilities used in conjunction with this request. Furthermore, I agree to provide the manpower necessary and will reimburse Delta State University for labor costs or damage costs as a result of this event.

To accept these terms, type your full name and initials in the spaces indicated below.
(initials)    (full name)