Facilities Use/Event Form

Email

Group/Committee/Organization Name

Contact name of person responsible for group?

Phone number of person responsible for group

Name of event?

Expected number attending?

Date of event (recurring information next box)

Month

Day

Year

If recurring event, please specify the frequency (ie, the second Tuesday of every month: every Monday in April Thursdays May 1st through May 29th)

Setup time for event

Time

HoursMinutes

Starting time of event

Time

HoursMinutes

Ending time of event

Time

HoursMinutes

Breakdown/Cleanup time of event

Time

HoursMinutes

Will a Breeze registration form be needed?

Yes

No

Any graphics needed?

Yes

No

Description of event?

What date should the announcement begin?

Where should the event announcement be distributed? Check all that apply.

Additional description of the event/meeting, which will be included in the publications checked above.