Event/Facilities Request Form
Booker T. Washington Center * 1720 Holland Street * Erie, Pennsylvania 16503 * (814) 453-5744 Extension 225*237*231
Email address *
MANDATORY INSURANCE RIDER FOR ALL SPACE/EVENT RESERVATION Please call Leann Brown @ 455-0987 ext.127 (Hart, McConahy & Martz Insurance Co.)
Organization/Individual request *
Name *
Email *
Address *
Phone number *
Alternate Phone *
Date you are requesting? *
Function Beginning Time? *
Function Ending Time? *
Set Up Time Required ? *
Practice Time Required ? *
What are you requesting to rent? *
Additional request (cost is not included in rental fee) *
Total Hours *
Clean Up Time Required ? *
Cash and money orders are expected means of payment. (No checks)
If more tables and chairs are needed than are available at the facility, the client is responsible for obtaining them
No open fire is permitted in/at the Booker T. Washington Center. Drug use or any Illegal Substance is PROHIBITED in or around the Booker T. Washington Center Campus
Will alcoholic beverages be served at this event? *
Please Note: The Booker T. Washington Center takes NO responsibility for the use of alcoholic beverages. If alcoholic beverages are being provided no minors (anyone under the age of 21) are permitted inside the building
Client Signature Required
Client Signature *
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