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LPC Facility Request Form
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Event Name *
Adult or Team Leader *
Phone Number *
Email Address *
Date of Event *
MM
/
DD
/
YYYY
Start Time of event Event *
Time
:
End Time of Event *
Time
:
If this is a recurring event please list additional dates needed
Room Requested *
Frequency *
Projected # of People *
Setup Time (if needed)
Time
:
Comments or Questions
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