Building Use Request

Date of Request*
MM slash DD slash YYYY
Name of Organization/Individual*
Contact Person*
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code
Email*
Phone
Purpose/Mission of Group/Individual
Type of Event*
Number of Attendees*
Requested Date of Use*
MM slash DD slash YYYY
Arrival Time

: Hours

Minutes
Event Time

: Hours

Minutes
Departure Time

: Hours

Minutes
Spaces Requested*
- Fellowship Hall (meals/activities)
- Classroom Space (sleeping quarters/sleeping bags)
- Showers
- Other
Will you need tables and chairs?

If so, include how many tables and chairs you need.
Will food/refreshments be served?
- Yes
- No
Other Information
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