Your Name (required):

Your Email (required):

Phone Number:

Name of Event:

Date of Event:

Time of Event:

Time In Building:

Time Out of Building:

Group Requesting Space:

Number in Attendance:

Open to the Public? YesNo

Childcare Provided? YesNo

If you intend to provide childcare, please call and arrange for it yourself.

I Need Accessible Space? YesNo

Space Requested (please list room/s, include rooms needed for childcare:

Person(s) Responsible:

Contact Email:

Contact Phone:

Indicate any special needs (i.e., tables, chairs, TV, computer, other equipment:

You are required to contact the Childcare Coordinator, to arrange for childcare.

Unless otherwise arranged with the Facilities Manager, you are required to do your own set-up, takedown, clean-up, etc. Please make certain that everything has been returned to where it belongs, turn off all electrical equipment and lights.

NO PARKING BEFORE 5:00 P.M. WEEKDAYS

This form will also put your event on the Society Calendar.
If this event is canceled, or the time is changed, please notify the Society Administrator immediately.