MSBC Facility Request Form

Mount Sinai Missionary Baptist Church

Facility Request Form
EVENT TITLE*
Date & Day of Event*

MonthDayYear
Date
Auxiliary/Dept/Ministry*
Contact Person*
Address
City
State
Zip Code
Telephone (work)*
home*
Email*
example@example.com
Facility Requested*
PLEASE NOTE: Preference will be taken into consideration, but please be flexible.
SET-UP REQUEST(S)
Expected Attendance*
Setup Date*

MonthDayYear
Date
Setup Time*
Event Date*

MonthDayYear
Date
Event Start Time*
Event End Time*
No. of 8 ft Tables*
No. of 6' Tables*
No. of Chairs*
No. of Round Tables*
Please see the diagram below to describe the desired table setup for your event.
Please be precise in your description
AUDIO/VISUAL & MISCELLANEOUS EQUIPMENT
Check all that will be needed

CD PlayerEaselOverhead/ ScreenStanding PodiumVCR/ DVD PlayerPA SystemChalkboardWhiteboardExtension CordPiano/ KeyboardTable PodiumTV MonitorOther
List Series Events Below
Month
Days
Time
Month
Days
Time
Month
Days
Time
FACILITY/EQUIPMENT RESERVATIONS WILL ONLY BE CONFIRMED UPON APPROVAL AND COMPLETION OF THIS FORM

PLEASE NOTE: EVENT COORDINATOR OR PROGRAM CHAIRPERSON IS REQUIRED TO MEET WITH FACILITIES MANAGER 24 HOURS PRIOR TO EVENT FOR FINAL SUMMARY
By signing this form, you acknowledge that you may be held responsible for any damage(s) to the facilities/ furniture/ equipment.
Responsible Party Signature*

Clear
Date

MonthDayYear
Date
Should be Empty:

Mount Sinai Missionary Baptist Church