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.


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.