Registration Form For Authorization To Serve
Alcoholic Beverages At University Events*
Lerner Hall Event Management
Alfred Lerner Hall, 2920 Broadway, New York, NY 10027
Phone 854-5825 Fax 854-5840
*All University sponsored events, regardless of location (on or off campus) or age of participants must be registered.

For Office Use

Assigned: ____________________________________  Event #:__________________________________
 
Please print the following information about the event: Anticipated number in attendance (ID required by all participants)
Date of the Event:_____________________________
Type of Event (Reception, Dance,
Party, Coffee House, etc.) _______________________
Location (building, room, etc.) ____________________
Start time for the event: _________________________
Closing time for the event: ______________________
A. Columbia Students (CUID): ________
B. Other Students (with ID): ________
C. Other (specify): ________
Total A+B+C = ________
D. Number of people under Age 21 ________
E. Age 21 and over: ________
Total D+E (should equal A+B+C) ________
 
Please check all the following that apply:
___Funded with University Funds___Publicized off campus___Publicized on campus only
___Charging for alcohol* ___Charging for admission*___Charging for tickets, T-shirts, other items, etc.*
___Held in a public place ___Open to the Columbia community  
* Requires a Temporary Wine and beer Permit License. An authorization letter from the University must accompany an organization application to the State of New York; applications are available from Dean of Students in each school. Note: It takes a minimum of two weeks to receive a Temporary License once the application is delivered to the State.
 
Alcohol (Amount of alcoholic beverages to be served in bottle/cases):
Wine:________Beer: ________ Hard Liquor or Punch (if money changes hands, cannot be served except in licensed premises): ________
# of Alcohol serving areas: ____________
Amount and kind of non-alcohol beverages to be served
(Should be equal or greater than alcoholic beverages being served)________________________________
 
Amount and kind of food to be served (Should be equivalent to 1 plate of food per person – food may be a combination of chips, vegetable tray, bean dip, cheese & crackers, etc. - please be specific) ______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
 
Organization/Group/Office Sponsoring Event:
Name: ____________________________________ Relationship to University: ____________________________________
Mailing address: ___________________________________________ Phone: __________________ e-mail: _______________________
 
On-Site Person Responsible for Event (must be 21 years old & attended Event Management Training):
Name: _________________________________ Relationship to the group/organization: ________________
Mailing address: _____________________________Phone: _________________ e-mail: ______________
Signature of person responsible for the Event: __________________________________ Date:___________
 
Names of Other Trained Event Managers (if requesting discount):
Name: _____________________________ Phone: ____________________ Email:_____________________
Name: _____________________________ Phone: ____________________ Email:_____________________
Name: _____________________________ Phone: ____________________ Email:_____________________
Name: _____________________________ Phone: ____________________ Email:_____________________
 
Recognizing Office/University Advisor for Organization:
Name: _____________________________ Title: ____________________ Office:_____________________
Telephone: _________________________ Fax: ______________________ e-mail:____________________
Department Account # charged for proctors:___________________
Proctors are generally assigned as follows: One proctor at door, one at each alcohol serving station and one roving proctor per floor of venue:
We request total proctors: _____ at door _____at serving positions ____roving proctor(s)
Signature of Advisor/Recognizing Officer: ___________________________________ Date: ___________
 
By signing this form, the organization sponsoring the event described on these pages, I agree to the following terms and conditions:
 
1. I will observe all Columbia University rules and procedures, as well as all state and local government laws and regulations regarding alcoholic beverages, in planning and carrying out the event.
2. I confirm that the sponsoring organization has contacted its recognizing office on campus to obtain permission to hold the event and, if applicable, has followed appropriate instructions and received authorization to obtain a Temporary Beer and Wine License. If such a License is necessary, I agree to provide the University with a copy of the License, at least two business days prior to the event.
3. I will fully cooperate with any proctors and University officers assigned to this event before, during and after the event, and I also recognize that the proctor has the final word if questions about alcohol procedures arise during the event.
4. If the event takes place in a residence hall, I agree to coordinate my activities with the appropriate Residence Hall Director or Dean or other building manager.
5. I agree to assist in identifying attendees at the event, including requiring those of legal drinking age to be identified with a wristband to be worn by them, or other appropriate and visible identifying device.
6. I agree to be responsible for my organization making full payments for use of the facilities, including any fees for the services of proctors.
Signature of person responsible for the Event: ____________________________________ Date:____________
This registration is not complete if this form is not read and signed by authorizing parties.
Fax completed forms to 854-5840 at least ten days prior to the event.


Columbia University Student Services