Request Hosted Use of the SpeakUpSis Empowerment Center
Thank you for your interest in the SpeakUpSis® Empowerment Center. Please complete this form to request your preferred date, time and space for your gathering or activity. All requests are reviewed prior to approval, and we will contact you to confirm availability and next steps for hosted use of the facility.
Contact Person Name
*
First Name
Last Name
Contact Person Phone
*
Please enter a valid phone number.
Contact Person Email
*
example@example.com
Company Name
Company Website
Company Phone
Please enter a valid phone number.
Company Email
example@example.com
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Activity Details
Activity Name
*
Event Type
*
One-Time Event
Recurring Weekly Booking
Recurring Monthly Booking
Start Date
*
-
Month
-
Day
Year
Date
Day of Week
*
Please Select
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Duration
*
Please Select
4 weeks
6 weeks
8 weeks
Ongoing until cancelled
Other
Will your group meet:
*
Weekly
Every other week
Monthly
Estimated length of each session
*
2 hour
4 hours
6 hours
Date of Event
*
-
Month
-
Day
Year
Date
Starting Time (including time for set up)
*
Hour Minutes
AM
PM
AM/PM Option
Ending Time (including time for clean up)
*
Hour Minutes
AM
PM
AM/PM Option
Activity Description
*
Activity Coordinator Name
*
First Name
Last Name
Expected Number of Attendees
*
This helps us recommend the best room for your group.
Preferred Space (Select one):
*
Small room (up to 10)
Medium room (up to 15)
Large room (up to 20)
Whole center
Not sure - recommend best option
Any additional information:
Booking & Payment
One-time events require a 50% deposit to reserve the date.
Recurring bookings require full payment for the first month to confirm your schedule.
Restrictions
No Smoking
No Pets allowed [Service animals are welcome but must be noted at time of booking.]
Illegal drugs and substances are strictly not allowed on premises
How did you hear about the SpeakUpSis Empowerment Center?
*
Social Media
Email
Google search
Referral
Church or organization
Event at the center
Other
Do you need a quick call before booking?
*
Yes, please contact me
No, I'm ready to book
Submit
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