Mesa Inter-Stake Center & Ellsworth Park Reservation Request Form
Email address *
DESCRIBE what is going to happen at this event: *
Your answer
Name of organization (Group, Ward, Stake, Family): *
Your answer
Number of people expected: *
Your answer
Date of event - 1ST CHOICE: *
MM
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DD
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YYYY
Date of event - 2ND CHOICE (if 1st not available. Enter repeating events 4 lines down):
MM
/
DD
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YYYY
What time will SETUP begin?:
Time
:
What time will your event BEGIN: *
Time
:
What time will your event END: *
Time
:
Repeating Event? (if yes include dates/times):
Your answer
First AND Last Name of person filling out this request: *
Your answer
Address (Street and City): *
Your answer
Phone #: *
Your answer
Name, phone #, and email address of person organizing the event: *
Your answer
Name of person who will ensure responsible use of facilities for this event (including damages and cleanup): *
Your answer
If LDS, list Ward and Stake name, & name and phone # of your Bishop and Stake President (that's 6 items of information you need to list here):
Your answer
If NON-LDS, is your organization:
If NON-LDS, do you have Liability Insurance?:
CHAIR USE POLICY/PROCEDURE: There are certain chairs assigned to each room, as designated by signs in rooms 101-107. You may bring extra chairs into these rooms (from the auditorium) but make sure the exact same chairs get put back into the same rooms when you are done. NO CHAIR CARTS IN ROOMS 101-107. When you are done with your event ensure the proper number/types of chairs are in place against the chair wall (as pictured on signs). Do you understand and agree to this chair use policy/procedure?: *
Areas you want to reserve (use diagrams at http://www.ldsisc.com/reserve_pics.htm as a reminder of what you'd like to request):
Do you need ISC equipment?: *
Required
Any additional information or comments?:
Your answer
I (we) have read and understand LDS standards and rules that apply to events on this property. I (we) agree with the those rules and conditions and will be responsible to make sure that those in my (our) organization are aware of and agree to abide by the same. I (we) agree to hold harmless the LDS Church and/or anyone associated with the use or maintenance of this facility from any claim that may arise from any accident, injury or other incident that may occur during our use of this property. We have also read and agree to rules contained at www.ldsisc/rules.htm *
By initialing below, I/we agree to all terms above: *
Your answer
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