Form

Event Request Form:

Event Information:
Full Name *

First Name Last Name
Event: *
Event Date: *
Start Time: *

: Hour Minutes
End Time *

- Month - Day Year
Additional Date:
Start Time:

: Hour Minutes
End Time

- Month - Day Year
Purpose for additional date:
Facilities Requested: *
Staff Requested: *
***Only White Street Staff can operate Audio/Visual Equipment owned by the church***
Additional Information or Requests:

Contact Information:
Primary Contact: *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *
Phone Number *

- Area Code Phone Number
*
Phone Number *

- Area Code Phone Number
*
Alternate Contact: *

First Name Last Name

Alternate Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Alternate E-mail *
Alternate Phone Number *

- Area Code Phone Number
*
Alternate Phone Number *

- Area Code Phone Number
*

Membership Information:
Are you or your spouse a member of White Street Baptist Church? *

Yes No
If no, are any of the following members of White Street Baptist Church? *

Your Parents Spouse's Parents Neither
If Applicable: Member's Name

Sign & Submit
Signature *

Clear
Date Signed: *

Terms & Conditions
Wedding Policy
Should be Empty: