Memorial Lutheran Church

Office: 2602 E. 28th St., Vancouver WA 98661

360-695-7501 (M-F, 9-1) Email:

Church Member: Facility Use Request  Updated: 3/4/2017


Make the request as simple as possible, one activity/venue per form. Example: Store food basket supplies, Bible Study series, decorate Easter eggs.

You will receive an email response after a review of this request.

*Required Information: Failure to complete these sections this request will not proceed or may be denied


*Today’s Date: ___________   *Name of Activity: __________________________________

*Contact Person: _____________________________________________________________

*Contact Phone:______________________   *Email: ______________________________

Criteria for use of Church rooms (exclusive of Parish Hall): Is this request for a Ministry or Church sponsored activity? Per Operations Ministry Area Leader

*Activity Description: ___________________________________________________________



*Room Preference:_____________________________ *Estimated Attendance: __________


*Frequency: Circle One;   Daily      Weekly        Every two Weeks      Monthly      Quarterly

*Time “Setup Staff” Enters and Leaves the Building: _______________________________

Submit completed form to  or submit request to the Church office, Office: 2602 E. 28th St., Vancouver WA 98661, 360-695-7501 (M-F, 9-1) .    

Thank you, Memorial Lutheran Church and Facilities Coordinator

Equipment: Notify Jim Wulf in writing or email ( 

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