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
Event Set-Up Date & Set-Up Start Time
*
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Duration in room (hours)
*
The total time must Include the setup, event, and breakdown time.
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
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
Duration (minutes)
Submit Form
Should be Empty: