Program Room Request Form

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Organization Name: *

Applicant Name and Position: *

Contact email: *

Contact phone number: *

Date of room request: *

YYYY

Day of room request: *

START Time (Please refer to our open hours when making your request; all meetings must end one half hour before closing time.): *

END Time (Please refer to our open hours when making your request; all meetings must end one half hour before closing time.): *

Is your organization a non-profit and/or 501c3? *

Yes

Other:

Is your meeting free and open to the general public? *

Yes

Description of meeting (please be as detailed as possible, include organization's nonprofit status, website, etc.): *

Any Special Requirements or AV Equipment needed? (please be specific): *

Description of room setup (Note: parties are responsible for both setup and breakdown of any furniture used): *

Chairs only, theater style (max capacity 80)

Chairs and tables, classroom style (max capacity approx. 50-60)

Chairs and tables, U configuration (max capacity approx. 50-60)

Other:

Expected Attendance (max capacity 80): *

GUIDELINES FOR PROGRAM ROOM USE:

- Masks are encouraged: an inherent risk of exposure to COVID-19 exists in any public place where people are present.

- Parties are responsible for complete setup and breakdown of tables and chairs

I understand and accept these room use guidelines, and take responsibility for ensuring all participants are aware of and will follow these guidelines: *

Yes

Required

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