APPLICANT CERTIFICATIONS AND AGREEMENT TO TERMS OF USE: (Please read carefully and sign. Application will not be considered if this section is not completed.)

On behalf of the applicant, I acknowledge by signing below that the Institution has made a copy of TBR Policy 1:03:02:50 and Northeast State Community College Policy 03:09:04 available for review. Applicant understands that submittal of this application shall constitute agreement by applicant to the following conditions, in addition to the conditions described in those policies:

1) The intended use of the Institution property and facilities by applicant does not violate, and actual use will not violate, the provisions of the Tennessee Board of Regents Policy on Use of Campus Property and Facilities or any policies or regulations of the Institution, or any federal, state, or local law or regulation.

2) Any use of college property and facilities pursuant to this application that is contrary to such policies, laws, or regulations or that is inconsistent with the activity as described in this application constitutes grounds for the institution to remove the activity from college property.

3) Applicant agrees to indemnify the institution and hold it harmless from liabilities arising out of applicant’s use of institution property and/or facilities, including but not limited to personal injury, property damage, court costs or attorney fees.

KACL