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(Complete and return to church office five working days before date of use.)

Personal Information:

Today’s Date: ___________________ Date(s) Needed: ______________________________

Function: _______________________ Bldg. Open from: _____________ to ____________

Person in Charge: ___________________ Meeting from: ____________ to ____________

Group/Person Requesting Use: ___________________________________________________

Home Phone ____________________ Work Phone ____________________

Person making request is responsible for cleanup; if different, please list person’s name on next line:

Person responsible for cleanup: ________________________________________________

Home Phone ____________________ Work Phone ____________________

Areas Needed: (Circle area(s) needed)

Supplies or Equipment Needed: (e.g. markers)

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Audio/Visual Equipment Needed: (Overhead, projector, podium)

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Will you need sound system? Yes _________ No ________ (Operated by person in charge of this area.)

Facilities Policies & Guidelines
and
Building Clean-Up and Set-Up Guidelines are attached.

PLEASE READ CAREFULLY AND COMPLY WITH ALL GUIDELINES.

For Office Use

Highlight areas of use on Policies and Guidelines, and attach this sheet to front of user's copy.

Non-Member Use:

Deposit Paid ____________ Total Fees ____________ Balance Due __________

Request Form, Policies & Guidelines given to:

Handed to: ______________________________________________________________________

Mailed to: ______________________________________________________________________

Faxed to: ______________________________________________________________________

Comments: _______________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Date entered on Master Calendar? _______________________________________________

A/V Personnel Contacted: _____________________________________________________

If Wedding, Clothes Closet Personnel notified of date: Yes _______ No ______

Keys

Key(s) issued? ___________ To: ________________________________________________

Date Key(s) Returned _________________________________________________________

Office Personnel ______________________________________________________________

Original given to Building Superintendent? ____________________________________