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.