SLUMC ROOM AND FACILITY USE AGREEMENT
St. Luke's United Methodist Church
52 16th Ave NW
Hickory, NC 28601
Phone: (828) 327-9837
Fax: (828) 327-4043
Email: stlukesumc1@gmail.com

Please complete entire form. Write "n/a" for any required questions where the answer is "not applicable."

Name of Organization:
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Contact Person's Name: (This person will be the liaison with the Administrative Assistant and the group reserving the facilities.)
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Non-Profit Status: (attach IRS determination letter)
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Federal ID Number:
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Address:
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Organization Day Phone:
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Fax:
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Email:
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Organization's Purpose:
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Event Name and Description:
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Date of Request: (Dates may not be SCHEDULED more than six months in advance, EXCEPT with special permission. St. Luke's cannot guarantee space requested until all fees are paid (see Covenant). Any changes to this form must be made and approved by the contact person.)
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Please Check One:
Required
Date(s) Requested
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Date(s) & Times for SETUP & BREAK DOWN:
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Event Start Time:
Time
:
Event End Time:
Time
:
Anticipated Number of Participants:
Will the event be...?
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