Meals-In-Lieu Sign-Up Sheet Event Date(s):

__________________________

Event Time: __________________________

Type of Meal(s):

__________________________ (Breakfast, Lunch, Dinner)

Event Name: __________________________

Programmer(s):

__________________________

Building:

__________________________

Phone:

__________________________

Email:

__________________________

ORL Supervisor Approval: ______________________ Signature

_______________________ Print Name

_______________ Date

Dining Manager Approval: ______________________ Signature

_______________________ Print Name

_______________ Date

**FORM IS DUE 4 WORK DAYS PRIOR TO EVENT** ** MINIMUM 15 GUESTS (SWIPES) ** MAXIMUM 60 GUESTS (SWIPES)** #

Type of Meal Plan (circle)

1

11 14 19 14P 19P

2

11 14 19 14P 19P

3

11 14 19 14P 19P

4

11 14 19 14P 19P

5

11 14 19 14P 19P

6

11 14 19 14P 19P

7

11 14 19 14P 19P

8

11 14 19 14P 19P

9

11 14 19 14P 19P

10

11 14 19 14P 19P

11

11 14 19 14P 19P

12

11 14 19 14P 19P

13

11 14 19 14P 19P

14

11 14 19 14P 19P

15

11 14 19 14P 19P

Name (Printed)

Signature

ID Number

# of Meals

Please understand that by signing up for this event you forfeit your right to obtain sack meals, meal coupons, temporary meal passes or to enter the residential restaurants for the meal(s) indicated above. Regular meal plan holders may only sign up for one meal for a Meal-In-Lieu event. Premium meal plan holders may sign up for multiple meals for guests. Guests must be other UCLA students or family members. Number of guests allowed for any Meals-In-Lieu event may be limited at the discretion of Dining Services. Misuse of the Meals-In-Lieu privilege will result in a $20.00 meal card fine and charges for any additional meals eaten.

(MEAL CARDS ARE NOT TRANSFERRABLE)