RMHCSC Kiwanis Community Room Reservation Request

1
What is the Name of your Group or Organization? * This field is required.Please include a short description of the purpose for the meeting. The Kiwanis room may not be used for social gatherings like showers, birthday parties, or other closed meeting.
2
The Group or Organization is* This field is required.Please select ONE. You will be contacted by RMHCSC if you are a For Profit Group or Organization
Non-Profit
For Profit
3
What is the name of the Point of Contact?* This field is required.The person listed will be the point of contact for this event.
First Name
Last Name
4
Please provide an email address for the Point of Contact* This field is required.
example@example.com
5
What is the phone number for the Point of Contact?* This field is required.
Area Code
Phone Number
6
What is the address for the Group/Organization?* This field is required.Please provide the address for Point of Contact if there is no Group/Organization address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Please provide the Name, Email, and Phone Number of the person responsible for the room IF different from the Point of Contact
8
What Date are you requesting the RMHCSC Kiwanis Community Room for? We need a minimum of three (3) business days' notice for scheduling.* This field is required.
Date
Month
Day
Year
9
Please provide a start time for your meeting.* This field is required.Please include time for set-up and clean-up. RMHCSC is not responsible for setting up the room. Reservation must be no longer than 3 hours. Meetings cannot start before 9am and must end by 8pm unless prior approval is given.
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
15
30
45
Minutes
AM
AM
PM
Until
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
15
30
45
Minutes
AM
AM
PM
10
What is the anticipated attendance for your meeting?* This field is required.There is a maximum of 25 people for the Kiwanis Room. You will be asked to provide a list of attendees on the day of the meeting.
1-5 people
6-10 people
10-15 people
15-25 people
25+ (meeting in main dining room; 5 business days lead time required)
11
Please let us know of any items you will need for your meeting.* This field is required.Please select all that apply. Please note that you are responsible for bringing a computer, mouse, and keyboard for use.
HDMI & TV
Conference Call Capabilities (you provide the set up)
Keurig (you provide K-cups and drinking cups/mugs)
Podium
Extension Cord
None of the above
12
Will you provide light snacks at your meeting?* This field is required.You are required to bring plates, cups, plastic ware, and napkins.
YESNO
13
I/We will provide a representative at reception to assist with welcoming your guests.* This field is required.You are required to have someone at reception if your meeting starts before 9am (volunteers do not start until 9a on weekdays/9:30a on weekends).
Agree
14
I/We will provide a Certificate of Liability Insurance naming the Ronald McDonald House Charity of Southern Colorado as the holder IF RMHCSC asks for it.* This field is required.
Agree
15
By submitting this form, I agree on behalf of the above named organization to be responsible for any damage sustained to the property while being used by the Group/Organization. I also agree to follow all rules set forth in the Kiwanis Community Room Policy & Guidelines and to leave the room neat and orderly.* This field is required.
Agree
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