MTSU Box 556, 1301 East Main Street, Murfreesboro, TN 37132 • Phone: 615-898-2104 • Fax: 615-898-5568
Name of Organization or Group _________________________________________________________________________
Contact Name ________________________________________________________________________________________
Phone (________) _________ - ______________ Alternate Phone (________) _________ - ______________
Address ______________________________________________________________________________________________
City ___________________________________________ State _____________________ Zip ______________________
Email ________________________________________________________________________________________________
Preferred Date ____________________________________ Preferred Time (from-to) ______________________________
Alternate Date ____________________________________ Number of Participants (
Max 35/session, Min 7
) ________________
Desired Program (see descriptions below)
Teambuilding Initiatives — 1 hour approximate
Low Elements (outside course) — 1-2 hours approximate
Index No. (
For MTSU Group
) __________________
High Ropes (Alpine Tower) — 2.5 hours minimum (1–16 participants) 4 hour minimum (17+ participants)
Combo (Team/Low/Alpine) — 4+ hour minimum depending on group size, call for confirmation
Group Development Initiatives— Activities are designed to get your organization communicating and engaging with each other in creative and unique ways. The focus is on developing stronger connections, building relationships, group interaction, and fun!
Low Elements— Activities are sequentially designed to allow your organization to experience mental and physical challenges in the pursuit of clearer communication, effective interactions, and enhanced performance. Group discussion is incorporated into these initiatives reinforcing listening, respect, planning, problem solving, and awareness.
Alpine Tower— Leave the ground and experience the 50-foot Alpine Tower—a place where people strengthen their self-confidence and generate renewed enthusiasm in their peers and themselves. The Alpine Tower can be the perfect half-day challenge for your organization or can be used in conjunction with a low challenge course program as a culminating experience.
MTSU Academic Class $40 per group $50 per group
Extra $2 per person fee for any MTSU academic class of over 35 participants
MTSU Student Group
Nonprofit or MTSU Faculty/Staff
Corporate Teambuilding
$8 per person
$10 per person
$18 per person
$10 per person
$14 per person
$22 per person
$55 per group
$15 per person
$20 per person
$30 per person
Reservation Instructions— Please call the Campus Recreation office for reservations or other basic information at
615-898-2104. This form must be filled out completely and received with reservation fee or MTSU account number by the Campus Recreation office at least two weeks before the reservation date. The Challenge Course Coordinator will then call the contact person to develop a specific program for the group. No reservation fee is required for student groups, but full payment of the group fee is due at the time of service. Reservation in NOT firm unless confirmed by phone or email directly from Challenge Course Coordinator. Please be flexible in the month of September because of very high volume of requests.
Cancellation/Weather— If program is canceled less than five days before the reservation date, the reservation fee will not be refunded. In inclement weather, the contact person must communicate with the Challenge Course Coordinator.
“No shows” will not receive a refund. We have an indoor facility for low ropes programs, and high ropes programs can be rescheduled.
0714-0854 – MTSU is an AA/EEO employer.

Signatures required on page 2, both pages required
Title of Event _________________________________________________________________________________________
Event Type (check one)
Student Sponsored
University Sponsored
Event Description
Academic Course Related
Co-Sponsored
External
Index No. ______________________________
MTSU Affiliated Organization ____________________________________________________________________________
Non-Affiliated/External Organizations (if applicable) _________________________________________________________
Total Event Expected Head Count ___________________ Age Group of Participants __________________________
Individual to be present and responsible ___________________________________________________________________
MTSU ID M# (if applicable) ____________________________ Cell No. ( ________ ) ________ - _______________
Date(s) Requested _____________________________________________________________________________________
Event Set-up Time _________ Start Time _________ End Time _________ Breakdown Time _______________
Location Requested _______________________ Room ____________ Room Expected Head Count ______________
Location(s) Requested
Gymnasium/Basketball Court(s)
No. of courts requested ______
Racquetball Court(s)
No. of courts requested ______
Intramural Fields
No. of fields requested _______
Outdoor Volleyball Court(s)
No. of courts requested ______
Set-up and
Special Needs
Indoor Soccer Arena
Indoor Suspended Track
Aerobics Room upper level
Meeting Room lower level
Lobby Area/Front Atrium
Lounge Area (Ping Pong)
Climbing Wall
Alpine Climbing Tower
Indoor Swimming Pool
Outdoor Swimming Pool
Sundeck
Other
Event Resources Requested
(check all applicable)
Chairs
Tables
Audio
DVD/Film/Video
Score Clocks
Sports Equipment
Food
Special Parking
Event Category (check one)
Agriculture
Do Not Publicize
Alumni Arts
Faculty/Staff Meeting
Athletics Conference/Camp/Lecture
Recreation/Wellness
Testing
Student Activity/Event
Other ____________________________________________________________________________________________
Event Website _________________________________________________________________________________________
NOTES • FOR OFFICIAL USE ONLY • DO NOT WRITE IN THIS BOX

Title of Event _________________________________________________________________________________________
Requestor/Sponsor Contact Billing Information (If different than requestor)
Name __________________________________________ Name __________________________________________
Phone (____) ____ - _______ Fax (____) ____ - _______ Phone (____) ____ - _______ Fax (____) ____ - _______
Address _________________________________________ Address _________________________________________
City______________________ State______ Zip ________ City______________________ State______ Zip ________
Email ___________________________________________ Email ___________________________________________
Applicant understands that filing of this application shall constitute agreement by applicant to the following conditions:
1. The intended use of campus property and facilities by applicant does not violate, and actual use will not violate, the provisions of Institution’s Use of Campus Property and Facilities
Scheduling Policy (MTSU Policy I:01:06), or any other policies or regulations of the Institution or the Tennessee Board of Regents or any federal state, or local law or regulation.
2. Any use of campus property and facilities pursuant to this application which is contrary to such policies, laws, or regulations of which is inconsistent with the activity as described in this application constitutes grounds for the Institution to remove the activity from campus property.
3. Applicant agrees to indemnify the Institution and hold it harmless from all liabilities arising out of applicant’s use of institution property and/or facilities, including but not limited to personal injury, property damage, courts costs, or attorneys fees.
4. User agrees to furnish proof of insurance or performance bond upon request by the Institution as required by MTSU Policy I:01:06.
5. Affiliated Entities are responsible for all activities that they sponsor that involve nonaffiliated Entities/Individuals, including all event communications with the appropriate scheduler through this application as well as the conduct of the nonaffiliated Entities/Individuals.
6. Requestor agrees to pay required deposit upon receipt of confirmation. Amount of estimated charges and deposit will be forwarded to requestor once they have been calculated.
7. If the User and/or its Agents will accept credit or debit cards in connection with its performance under this Agreement, User agrees that it will at all times during the performance of this
Agreement comply with current Payment Card Industry Data Security Standards (PCI DSS).
Applicant acknowledges that the Institution has made a copy of its Use of Campus Property and Facilities Scheduling Policy (MTSU Policy I:01:06) available for review at http://www.mtsu.edu/policies/ and understands that a physical copy of such policy will be provided upon request and payment of reasonable copying charges.
Rlease refer to the Policy Manual via www.mtsu.edu/camprec for further policies, rules and regulations.
This agreement states that I, (print name) _________________________________, have read and will abide by the policies set forth by the MTSU and Department of Campus Recreation. These policies are to be followed without exception unless otherwise set forth and included in this agreement.
Requestor Signature ___________________________________________________ Date _________________________
Return to: MTSU Campus Recreation, MTSU Box 556, Murfreesboro, TN 37132 • Phone: (615) 898-2104 • FAX: (615) 898-5568 • www.mtsu.edu/camprec
MTSU Student Groups
Authorization ___________________________________ _______________________________ Date _____________
Department Dean / Administrative Officer / Advisor Signature Print Name
Authorization Email ____________________________________ MTSU Authorization Phone ______________________
Student Affairs Authorization (required for Student Organizations only) Approved Disapproved
_______________________________________________ _______________________________ Date _____________
Leadership and Service OR Office of Fraternity and Sorority Life Signature Print Name
Facility Authorization
FOR OFFICIAL USE ONLY • DO NOT WRITE BELOW THIS LINE
Approved Disapproved
_______________________________________________ _______________________________ Date _____________
Print Name
Program Authorization Approved Disapproved
_______________________________________________ _______________________________ Date _____________
Print Name
Program Authorization Approved Disapproved
_______________________________________________ _______________________________ Date _____________
Print Name
*Reason for reservation not being approved (if applicable) ______________________________________________________
Approved _____/_____/_____
Not Approved* _____/_____/_____
Cancelled _____/_____/_____
Reservation Fee $_______________
Receipt No. ________________
Date of Receipt _____/_____/_____
Amount of Rental $_______________
Receipt No. ________________
Date of Receipt _____/_____/_____
0213-517 – MTSU is an AA/EEO employer.