Group or Individual requesting use
Date
-
Month
-
Day
Year
Phone Number
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date(s) Requested
-
Month
-
Day
Year
If recurring - Start Date:
-
Month
-
Day
Year
Hour Minutes
AM
PM
AM/PM Option
End date:
-
Month
-
Day
Year
Hour Minutes
AM
PM
AM/PM Option
Back
Next
Member or regular attendee who will be present:
First Name
Last Name
Email Address
example@example.com
Do you have access to the building (key)?
Yes
No, I will need access to the building
Facilities needed (please tick all rooms you plan to use):
Multi-purpose Room (Worship Center)
Kitchen
Library/Conference Room
Classroom(s)
Please specify how many
Equipment needed:
TV/VCR/DVD
PowerPoint
Boombox
Sound System
Overhead Projector
Coffee Pot(s)
Please explain activity to be held:
Submit
Should be Empty: