| Name of organization, group or individual: |
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| Primary Contact |
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Name:
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Email:
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Day Phone:
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Evening Phone:
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Mailing Address:
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State:
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Zip:
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| Secondary Contact |
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Name:
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Day Phone:
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Evening Phone:
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| Name of Client: |
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| - Nature of Shoot - |
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| Duration of Shoot: |
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Estimated Number of People: |
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| Detail Scope of Production (attach additional sheet of paper if necessary) |
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Request Date(s):
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Date(s):
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Begin Time:
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End Time:
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| Location(s) of Shoot: |
Check all the apply and be very specific |
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Other:
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| Please provide Names and Titles of all people who will come onto the campus for shoot. |
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| List all vehicles brought onto campus. Indicate (*) those needed at the shoot site(s). (Attach an extra sheet of paper if necessary) |
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Vehicle Make
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Vehicle Model
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License Plate Number
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Vehicle Color
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| Location Fees: |
Location fees for photographic use of University of St. Thomas Campus |
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Film/Video:
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Full Day (6 to 12 hours)
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$2,000
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1/2 Day ( to 6 hours)
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$1,000
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Still Photos:
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Full Day (6 to 12 hours)
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$500
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1/2 Day (1 to 6 hours
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$250
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| Payment terms: Check or credit card accepted. Payment due prior to on-campus visit. |
| Note: Additional Charges may be required for shooting outside normal staff hours and /or for unusual power, security, or site preparation requirements. |
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| TERMS OF AUTHORIZATION |
| I have read and understand the University of St. Thomas Photo Shoot/Filming Authorization Packet. I understand the conditions governing the activities described therein. In order to receive this permit, I have submitted this packet explaining and describing my full intent in detail. I hereby understand that failure to stay within the confines of this authorization document may result in the revocation of said authorization at the full discretion of the university at any point in time. |
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Applicant Name:
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