Facility Request Form

Facility Use Request Form
Please make sure to read the Facility Use and Guidelines BEFORE submitting your request.

(*indicates required information )

Applications and requests for the Presbytery facility use must be received no less than four weeks prior to the requested date of an event. Questions or special interpretations may be referred to the Business Administrator - 412-323-1407.
Organization Name*
Contact Name*

First NameLast Name
Organizational Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact E-mail*
Phone Number*

Area CodePhone Number
Cell Number (optional)

Area CodePhone Number

Facility Use Request Form
Event Name*
Purpose of Meeting*
Date Requested*

MonthDayYear
Start Time*
AM / PM*
End Time*
AM / PM*
Please complete this section if your request is for a repeating meeting.

i.e. the first Thursday of each month.

Facility Use Request Form
Event repeats
Monthly Repeat
Day of Week
Conference Room AConference Room BRooms A & BPatrick RoomChapelOther
Total Number Attending*
Tables Requested
Chairs Requested
Other Requests or Questions

Facility Use Request Form

Please Read:	All non-affiliated, non-profit organizations requesting use of the facility are required to forward a copy of their Certificate of Liability Insurance with the application. Your application for facility use will not be considered unless a valid certificate of liability insurance is received with this application. Certificates of liability are usually available free of charge and may be obtained by contacting your insurance carrier. You may mail your certificate with this application or have your insurance carrier mail the certificate to us. You may also have the certificate faxed to our office at 412-323-2256.
Setup Time:	A minimum of one hour before and after the scheduled time of your event will be required for scheduling purposes. A reserve time of one hour before and after your event will be scheduled if no reserve time is indicated. Please consider the proper time allocation necessary to set up or tear down for your event as the assigned room may be scheduled for another event prior to or after your event. The Pittsburgh Presbytery cannot be responsible for your failure to not allow for proper reserve time scheduling. Furthermore, The Pittsburgh Presbytery cannot be held responsible if your assigned room cannot be made available to you for setup purposes due to your failure to not allow for proper reserve time scheduling.
Schedule of Contributions:	Non Affiliated Groups - The Pittsburgh Presbytery has established a schedule of contributions which are used to offset the costs of equipment, utilities and custodial services. These contributions are kept at a minimum wherever possible and do not reflect a rental of our facility. The Contribution Schedule may be changed at any time by the Pittsburgh Presbytery and the new Contribution Schedule will be applied to all new requests as they are made. Requests submitted prior to any Contribution Schedule change will be collected at the prior Contribution Schedule.

Contribution Schedule

Conference Room A - $20

Conference Room B - $25

Conference Rooms A&B - $50

Chapel - $50

Patrick Room - $100

Custodial Services - $25 per room, per hour

I / we have read and agree to follow and abide by the Facility Use Guidelines as approved by the Pittsburgh Presbytery.
Should be Empty:

Facility Use Request Form

Facility Use Request Form

Facility Use Request Form

Facility Use Request Form