Asian Health & Service Center Rental Application
Please submit an application for rental space request. Reservations are accepted only upon confirmation from Rental Coordinator and signed usage agreement.
Email address *
Organization Name
Name (Please list any other setup coordinators) *
Address
Phone Number *
Classification *
Required
Nonprofit ID#
Event Description *
Need to provide detailed floor plan and logistics 2 weeks before event for Hall 1, 2, 3, and Banquet Hall.
Event Day *
Required
Event Date *
MM
/
DD
/
YYYY
Event Start Time *
(including setup)
Time
:
Event End Time *
(including cleanup)
Time
:
Estimated Attendance *
If ongoing event, please indicate:
If ongoing request, please indicate:
Will There Be Food? *
Catered Event? (Cleanup fee - $150 may apply) *
Will Kitchen Be Used? ($100/hr) *
Must provide a detailed plan 2 weeks before event (4 weeks for banquet). Food prep and warmup only. Cooking is not permitted.
Caterer Name
Caterer Phone
Will alcohol be served or consumed? *
Do you have an alcohol permit? *
If yes, permit is required.
Would you like to use the Audio Visual Equipment? (training is required) *
Describe your AV needs in detail *
Will you be bringing a laptop or USB? If you need extension cords, let us know. Please help us know how to best accommodate a successful meeting/event with you.
Wired Microphones? *
Available Only On 3rd Floor Halls
Wireless Microphones? *
Available in Hall 3 Only
How many tables (rectangular) and chairs will you need? (Up to 6 per table):
Is this event open to the public? *
Will admission be charged? *
Will children under 18 be present? (Children under 18 will need to be supervised by a parent or guardian) *
Will items be sold? *
Will decorations be used? (Please describe)
Will the purpose of this event or meeting include the promotion or opposition of political candidates, committees, referendums, recall petitions, and/or ballot measures? *
Will you provide a certificate of insurance? *
Room Description
Banquet Hall - (380 people)
$2500 per 8 hours - Non-operating hours - Combines Halls 1, 2, 3
6000 sqft. Includes built-in AV system with large 120” screen, 3-90” flat screen displays, 2 wireless mics, and 4 wired mics.

Hall 1 - (105 people)
$500 per 8 hours: Monday-Friday 9am-5pm
$700 per 8 hours: Non-Operating Hours
1600 sqft. Includes built-in AV system with large 90” flat screen display, and 2 wired mics.

Hall 2 - (120 people)
$700 per 8 hours: Monday-Friday 9am-5pm
$800 per 8 hours: Non-operating hours
1800 sqft. Includes built-in AV system with large 90” flat screen display and up to 2 wired mics.

Hall 3 - (155 people)
$800 per 8 hours: Monday-Friday 9am-5pm
$1000 per 8 hours: Non-Operating hours
2300 sqft. Includes built-in AV system with large 120” screen, a 90” flat screen display, 2 wireless mics, and 4 wired mics.

Lobby - (100 people)
$200 per hour: Non-Operating hours:
1000 sqft. Includes built-in AV system with large 70” flat screen display and 1 wireless mic.

Training Room 201 - (30 people)
$75 per hour - M-F 9am-5pm
$100 per hour - Non-Operating Hours
420 sqft. Includes large 90” flat screen display and computer.

Board Room 203 - (10 people)
$75 per hour: Monday-Friday 9am-5pm
$100 per hour: Non-Operating Hours
340 sqft. Includes large 80” flat screen display and computer.

Kitchen
$100 per hour
Food Preparation and warm up only.

Terrace
Monday-Friday: 9am-5pm: $100 per hour
Non-Operating Hours: $150 per hour
Room Type *
Please select the type of room you need - A/V equipment, computers, and white board available in all rooms
Required
Please provide name and phone number of person who will be stationed at the entrance. Person will need to stand by to open the door outside the hours of M-F 9am-4pm. Please provide any additional comments or questions you would like us to know. *
Security Deposit and Guidelines
-A $250 security deposit is required to confirm your reservation within two weeks of application or event date, whichever comes first.

-A door attendant is required at the 1st floor entrance door for events after 4pm as doors will be locked for security purposes.

-Please return the conference rooms and halls to the original condition you found them in. Pictures are available on the website. AHSC will provide tables and chairs, but will not help with setup.

-AHSC has 57 parking spots. During operating hours from M-F 9am-2pm, parking is reserved for AHSC clients. Outside operating hours, parking is first come, first serve. If additional parking is needed, please submit a request.

-Parking is not available at the Willamette Dental Group building. Side-street parking is available.

-Certificate of insurance is required with Asian Health & Service Center named as additional insured.

-Please include time in your rental period for set-up, decorating, and cleanup.

-Reservations require a signed rental agreement and security deposit.

-Rates subject to change anytime.

-Please be aware that there will be community programs and noise during normal operation hours.
By submitting this form, you agree to the guidelines. We reserve the right to change these terms and conditions at any time without prior notice. *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy