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WBI Facilities Usage Request Form
Please fill out this form to request using the Writer's Block activity space for an upcoming event. Scheduling is on a first come first serve basis.

Rental Rate: $20/hr. A $10 non-refundable down payment is required to hold the date. Writer's Block reserves the right to cancel the reservation if there is not down payment to hold the date, or for Writer's Block necessary business, in which case the down payment will be refunded. Details will be emailed in the form of memorandum of understanding. This form is not binding untilo payment and contract has been completed.

*PLEASE EMAIL OUR ADMINISTRATIVE COORDINATOR WITH AN QUESTIONS, COMMENTS, OR CONCERNS THAT YOU MAY HAVE: gmccool.writersblock@gmail.com, or call us at 860-442-5625*

Email address *
Please describe the type of event you will be using the space for. *
Your answer
Name of organization hosting event:
Your answer
Name of individual responsible for event: *
Your answer
Phone Number
(optional if you prefer contact by email only)
Your answer
What is the date of your request? *
MM
/
DD
/
YYYY
What time will you be arriving? *
Time
:
What time will you be vacating the space? *
Time
:
Please choose one of the following options for payment (keep in mind that the date will be confirmed once down payment/payment has been received):
Submit
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