152 Pearl Street
Your Name (required):
Your Email (required):
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:
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.
Duke Duchscherer January 21
Services at 9 and 11 a.m.