UNIVERSITY RELEASE AND INDEMNIFICATION AGREEMENT EXHIBIT

Form Instructions

1. Enter name of University Campus
2. Enter the purpose of use of University facility by Non-University Group
3. Enter the name of the organization requesting use of a University facility
4. Enter the University premise (specific location) to be used by organization
5. Enter the date the premises is to be used
6. Enter the starting time - include AM or PM
7. Enter the ending time - include AM or PM
8. Enter the name and title of the organization's officer authorized to obligate the organization to all terms of the agreement
9. The organization officer must provide either a hand-written signature or provide their digital ID
10. If the organization's officer applies a hand-written signature, enter the date the form is signed. If a digital ID applied, skip this field
11. Enter the telephone number, including area code, of the organization's officer
12. Enter the email address of the organization officer
13. Enter the name of campus or college contact person
14. Enter the Penn State University email address of the contact person
15. Enter the office telephone number, including area code, of the contact person