Event Name :

Adult or Team Leader:

Phone Number:   Email address:

Date of Event: (MM/DD/YY) Start Date (if recurring):

Time of Event: From                       End Date (if recurring):

                      To:

Room Requested:                Frequency: Weekly Monthly Bi-weekly Other One-Time

If recurring and you selected other, please explain:

Projected # of people in attendance:

Set up requirements:

Set up Time if needed:   

If other set up requirements, please explain:

You should be contacted within 3 working days to confirm your request.  If not contacted, please call Brenda Bingham, 932-2751.