PA Wilds Media Lab Space Request Form
To reserve a space at the PA Wilds Media Lab at 61 N. Fraley St., 2nd Floor, Kane, PA 16735, please complete the form below. This helps us to understand your needs and process your request promptly. Please note: submission of this request form does not guarantee use. Spaces are available on a first-come, first-served basis. Once your request is received, you will receive a response from the PA Wilds Center team within 24-48 business hours.
Organization / Business Name:
*
If not applicable, enter N/A.
Name
*
First Name
Last Name
Phone:
*
E-mail:
*
example@example.com
Room Preference:
*
Please Select
Front Hall / Entry
Flex Space
Conference Room
Photography Room
Audio-Visual Room
Break Area / Kitchen
Reservation Type:
*
Please Select
Personal / Professional Use
Meeting / Conference
Club / Organizational Event
Media Lab Tour
Requested Date:
*
-
Month
-
Day
Year
Select the date that you want to reserve.
Proposed Start Time:
*
Please Select
9:00 AM
9:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
3:30 PM
4:00 PM
4:30 PM
5:00 PM
Proposed End Time:
*
Please Select
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
3:30 PM
4:00 PM
4:30 PM
5:00 PM
5:30 PM
6:00 PM
6:30 PM
7:00 PM
7:30 PM
8:00 PM
8:30 PM
9:00 PM
Any Special Request?
Submit Form
Should be Empty: