UAS Alcohol Beverage Service Permit Application

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UAS Alcohol Permit Request

Applicant Information

First Name:

Last Name:

Email Address:

Phone Number:

Event Information

Event Date:

Event Location:

Event Time:

Is there a fee to attend?

Event is:

Will minors be able to attend?

Purpose of Event:

Description of Event:

Terms and Conditions: In making this request, I have read and take responsibility for complying with the UAS Alcohol Policy. I understand that I will be responsible for monitoring the event to ensure compliance with the Policy and all applicable laws, ordinances, and regulations. The applicant will be present during the entire event and will maintain a copy of the approved request on site.

I have read and agree with the terms and conditions.

Chief of Staff Review

Status

Notes/Conditions:

Initials

Please read the Disclosure / Consent before you sign your form electronically.

Typing your name exactly as it appears below signifies you are completing this form using an electronic signature. By signing electronically, you are certifying that you have read and understand the Disclosure/Consent and agree to electronically sign. You also agree to receive required disclosures or other communications related to this transaction electronically.

To continue with the electronic signature process, please enter your first name in the first field, and your last name in the second field. Your name must match the names displayed in the dialog. Next, click the "Sign Electronically" button to save your information and submit your electronic signature.

Please review your name and try again

If you would like to opt out of electronic signature, please click the "Opt out and print" link below to save your information and print a local copy for your signature.

I have read the opt out instructions provided and understand my responsibilities associated with my opt out decision.

Opt out and print

Date

Chancellor Approval