Selu Retreat Center Service Request Form (SERF)General Public Use

Date(s) of Event: Time(s) of Event: Number of People:

Name of Sponsoring Organization:

Name of Primary Contact:

Contact Mailing Address:Phone #: Fax #:

Contact E-Mail Address:

Retreat Center Use: Number of days to be used @ $275.00 per day Total $ Amount

Overnight Accommodations: Per Person @ $30.00 each # of people Total $ Amount

Linen Units (if desired): Per unit @ $10.00 each # of linen units Total $ Amount

Canoe Rental: Number canoes @ $8.00 each, per day Total $ Amount

# of days # canoes requested

Subtotal:

(Office Use Only) Tax:

Grand Total:

Notes:

This form must be completed in its entirety prior to confirmation of the reservation. I understand that the completionof this form acts only as a request for services and is subject to approval by the Director of Selu. I also understand thata signed Facility Use and Service Agreement must be completed and attached to this SERF prior to the Event.

Signature-Sponsoring Organization designated representative Date

This SERF must be returned within ONE WEEK of receipt

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Selu/RU Contact Numbers: Jeff Armistead, Director of Selu (540) 320-1977

Selu Retreat Center (540) 831-7018

Conference Services Office (540) 831-5800

University Services (540) 831-5524

Selu Fax Number (540) 831-7017

RU Police Department (540) 831-5500

Catering Services:

Meals at the Selu Conservancy are required to be catered by the Radford University Dining Services vendorin accordance with contractual regulations. For Catering Services, contact (540) 831-5477. Seperate billingfor catering service is required.

Will your Sponsoring Organization require catering services? Yes No

If authorization is received prior to the event to use a caterer other than Radford UniversityCatering Services, the Sponsoring Organization is responsible for trash removal.

General Information:

Reservations are made on a first-come, first-served basis and will be confirmed only after receipt of a completedFacility Use and Service Agreement, a completed Service Request Form, and payment of 25% of the total due.

Sponsoring Organizations contracting with Conference Services should not directly contact the Selu Director.Conference Services staff will schedule and bill for use of Selu facilities.

An invoice, with the balance due, will be sent to the Sponsoring Organization once the event is complete.

Payments should be made payable to Radford University and remitted to: Radford UniversitySelu ConservancyPO Box 6992Radford, VA 24142-6992Attn. Jordan Stump

If required, the Sponsoring Organization shall provide a copy of the Certificate of Insurance to Radford Universityno later than 10 days before the Event begins.

For more information regarding Selu Conservancy go to the following website:

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http://www.radford.edu/content/selu/home.html_____________________________________________

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