2025 ROOM REQUEST FORM

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*Facility requests are subject to Executive Director approval only. Requests are not final unless approved and confirmed by the Executive Director via signature.

*There is wheelchair accessibility to the second floor. We have an elevator.

Name of the Organization *

Address *

City *

Zip Code *

Name of the person in charge of the event *

Are you over 18? *

Yes

Primary phone number *

Alternative phone number

Email *

For how many peoples? *

Requested start date & time *

YYYY

Time

Requested end date & time *

YYYY

Time

If you are bringing any special equipment, please explain what kind of equipment you are bringing. The Center is not able to provide tables, chairs, and equipment.

Name of All Peoples Staff involved in this event if any

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