Facilities Request Form

Name of Organization

Name of Person

Email Address

Telephone Number – Home

Telephone Number – Work

Event

Facility Requested

Request Key(s)

Estimated number of people attending

Date Needed

Time Requested – Preparation

Time of Actual Event

Time Requested – Cleanup

Additional Equipment

PA System:
No Yes

Projector:
No Yes

Screen:
No Yes

Any Other Equipment Needed

Additional Notes