Use of The Dunbar Facility
This questionnaire must be completed and submitted to the rental staff of Mt. Zion Baptist Church for their review and approval before any individual or organization will be allowed use The Dunbar at 33 Oak Street, Springfield, MA. It must be submitted no later than 21 days prior to the date of your requested event.
I. General Information about Organization
Name of Organization *
Your answer
Mailing Address *
Your answer
Phone Number *
Your answer
E-mail *
Your answer
Primary Activity in which Organization is engaged*
Your answer
II. Contact Person Information
Name of Contact Person (First & Last) *
Your answer
Position with Organization *
Your answer
Mailing Address *
Your answer
Phone Number *
Your answer
E-mail *
Your answer
III. Organization Information
Is this Organization organized or operated for profit? *
Is this Organization a non-profit organization engaged in exempt activities? *
If yes, please provide a copy of your IRS determination exemption letter [e.g., 501(c)(3) document, etc.] with this questionnaire. If an IRS determination letter is unavailable, please furnish us a copy of your Articles of Incorporation, Organization Brochures, Letter of Recommendation, or other source of information disclosing the purpose of your organization. Please indicate here which document(s) you are providing.
Your answer
Have you made contact with any local non-profit facilities (e.g., community centers, etc.)? *
If yes, reason(s) other facilities are not appropriate for your proposed event.
Your answer
IV. Event Information
What is the purpose and/or nature of the proposed event that your organization intends to sponsor in our facility? *
Required
If other, please explain.
Your answer
Requested Date(s) *
Your answer
Requested Time(s) *
Your answer
Length of Time *
Your answer
How will event participants' entry be controlled? *
Required
If other, please explain.
Your answer
Will there be a financial charge to attendees? *
If yes, how much will the charge be? (If no, write "No Charge.") *
Your answer
Will anything be sold or distributed in association with this event? *
Please describe.
Your answer
How many people are expected to attend the event? *
Your answer
What portion of our facility are you requesting to be utilized in conjunction with this event? *
Required
V. Special Set-up Requirements
Describe in detail any proposed set-up needs by time of need and number of items (e.g., chairs, long tables, etc.)
Your answer
VI. Food Services
Will there be food at this event? *
If yes, describe in detail any proposed food services associated with this event, and who you plan to use to provide these services. (If no, write "No Food.") *
Your answer
VII. Concluding Information
This questionnaire will be reviewed and our response will be returned to you by mail or e-mail. If you have any additional questions, you can call us at (413) 785-5664.
Please furnish any additional information or explanations which you feel would be helpful in evaluating your request.
Your answer
By checking the box below and submitting this form, you and your organization affirm the information included is true and correct. *
Required
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