Community Center Reservation Request
Please fill the form below accurately to enable us serve you better!
Title of the Event
*
Event Leader Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Start Time of Event
*
ex: 11:00 am
End Time of Event
*
ex: 5:00 pm
Event Fee for Attendees:
*
Reservation Required
*
Yes
No
Name of Contact Person
*
First Name
Last Name
Contact E-mail Address:
*
example@example.com
Contact Phone Number
*
-
Area Code
Phone Number
Website
Event Description
*
0/1000
Set-up Time
*
Breakdown Time
*
Your Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
*
-
Area Code
Phone Number
Would you like the event to be promoted on the Events page of the website
*
Yes
No
Would you like the event to be promoted on the Health Touch NC Facebook & Instagram accounts?
*
Yes
No
Submit Form
Should be Empty: