Facility Request Form
Step 1 of 2: Submit
Requestor Name
*
Date Submitted
*
Home Number
Work Number
Cell Number
E-mail
Ministry Name (if Applicable)
Room(s) Requested
Date(s)
Description of Function
Start Time of Event
End Time of Event
Age Span of group attending?
Number of People
What date & time do you need to set-up and clean-up?
Set-up or Clean-up Required?
Yes
No
Set-up date and time?
Clean-up date and time?
Event Needs
Number of Chairs?
Number of Tables?
Are you serving refreshments?
Yes
No
Media Support?
Yes
No
Microphone?
Yes
No
Overhead Projector? (Requestor must provide their own laptop)
Yes
No
Sound Technician (Additional fee)
Yes
No
Special Room Set-up?
Yes
No
*
indicates required fields