Do you have a PROGRAM, ACTIVITY, or EVENT idea?
PLEASE VOLUNTEER your time and we will provide the space.
All programs at Rebel are free for the public. We DO NOT charge admission or fees for services.
Please fill out the questionnaire and we will review your proposal:
Your Contact Information:
Today's Date
*
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Month
-
Day
Year
Date
Your Email
*
Your Name
*
First Name
Middle Name
Last Name
Suffix
Your Organization (if applicable)
Your Address
Street Address
Street Address Line 2
City
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State
Zip Code
Your Mobile Number
*
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Area Code
Phone Number
Additional Contact Information:
Please include if there is a second person or additional point of contact. (Otherwise, leave blank.)
1. Proposed Idea Name
*
2. Is this one-time or repeating (reoccurring)?
*
One-Time
Reoccurring
3. How would you describe this to the community?
*
What is the purpose of this event? What are the benefits or goals? Who would be interested in coming (target audience)?
4. When are you interested in holding this? Indicate first and second options.
*
Please list the possible day(s), date(s), and time(s). If the event is repeating, describe if it is monthly, weekly, etc.
5. What is the earliest start (availability) date?
*
-
Month
-
Day
Year
This is a tentative date pending review.
6. What materials or equipment will you be bringing or need?
Please describe any setup needs you need for the space. What materials and equipment you will be using or bringing?
7. What else should we know?
What else would you like to tell us about you or your idea?
Additional Contact Information:
Please fill out this section if there is an additional point of contact. (Otherwise, leave blank.)
Alternate Contact Name
First Name
Last Name
Alternate Contact Email
example@example.com
Alternate Contact Phone Number
-
Area Code
Phone Number
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