Facilities Request Form

Group or Committee:

Contact Person:

Contact Phone Number:

Mailing Address:

E-Mail Address:

Event Information

Date(s) of Meeting:

Additional Date(s) of Meeting:

Day(s) of Week:

Event Name:

Number Attending:

Room Requested :

Number of Tables:

Number of Chairs:

Indicate any advance preparations (special needs, arrangements, set-up)

Check the box if you will need any of the following
KitchenServing EquipmentPianoCustodial ServicesPodiumMicrophoneScreenMultimedia ProjectorTV / DVDTV / VCRSlide ProjectorTape RecorderPaper on tablesExtension CordSurge ProtectorCD player