• Name of Organization
  • Contact Person
    First
    Last
     
  • Address
    Street Address
    Address Line 2
    City
    State / Province / Region
    Zip / Postal Code
    Country
     
  • Phone Number
    (###)
    -
    ###
    -
    ####
     
  • Email

  • Event Information

  • Date of Event
    MM
    /
    DD
    /
    YYYY
     
  • Beginning Time
    HH
    :
    MM
    :
    SS
     
  • End Time
    HH
    :
    MM
    :
    SS
     
  • Number of Attendees
  • Name of Event
  • I have reviewed the Room Rental Policies *
    Yes
    No
  • Room(s) Requested
    Children's Center
    Counseling Room
    Volunteer Room
    Conference Room
    Kitchen
  • Total Hours Requested
    1-4 hours, $25
    4-8 hours, $50
    8 hours or more, $100