Black Box Theater Reservation Request Form
MPTCS - 125 Sussex Avenue - Newark, NJ 07102 - E: BlackBoxTheater@mptcs.org - P: 973-621-0060 Ext.2013
For external organizations, networks, and establishments, please fill in the highlighted chart fields.
Name (First and Last Name) *
Your answer
E-Mail *
Your answer
Which campus site is requesting space in the Black Box Theater?
Date of Event (please provide 1-2 alternative dates) *
Your answer
Start Time
Time
:
End Time
Time
:
Please list your Audio and Visual needs, instruments, and special request(s).
Your answer
How many attendees are you expecting?
Your answer
Please describe the Scope of the Event.
Your answer
If tickets are being sold, please list the cost of admission.
Your answer
Do you need parking accommodations?
For External Organizations, Networks, and Establishments
Please list the name of your organization.
Your answer
Type of Organization
Address
Your answer
Business Telephone Number:
Your answer
EIN Number:
Your answer
Name of Organization's Contact:
Your answer
Phone Number
Your answer
E-Mail Address
Your answer
Do you have required insurance coverage in the amount of $100,000/$300,000?
Thank you for submitting this request! You will receive a response from the Office of the Superintendent/CEO within 24 hours of submission. For immediate assistance, please e-mail: BlackBoxTheater@mptcs.org or call 973-621-0060, Ext. 2013.
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This form was created inside of Marion P Thomas Charter School.