Event/Facilities Request Form 2022
Booker T. Washington Center * 1720 Holland Street * Erie, Pennsylvania  16503 * (814) 453-5744
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Email *
MANDATORY INSURANCE RIDER FOR ALL SPACE/EVENT RESERVATIONS (FORM CAN BE DOWLADED AND PRINTED FROM OUR EVENT PAGE UNDER REQUIREMENTS) Please contact Pam Lindberg @ 455-0987 ext.116 (Hart, McConahy & Martz Insurance Co.) Applicant may obtain their own insurance carrier.
All APPLICANTS MUST BE 21 & UP AND BE ABLE TO PROVIDE PROOF OF AGE
Organization/Individual request *
Name *
Address *
Phone number *
Alternate Phone
Date of Birth *
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YYYY
Age *
Date you are requesting *
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DD
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YYYY
Event Planning
Type of Function ( be specific please) *
Function Beginning Time? *
Time
:
Function Ending Time? *
Time
:
Setup Time Required? (Set up time must be within 2 hrs. of event) Additional time is $25 per hour. *
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