Facility Request - Bethany Presbyterian Church

Phone Number *

Address *

Affiliation *

Organization Name

Meeting Purpose *

Start Date *

End Date *

Day of Week *

Frequency *

Recurring Week (if recurring Monthly or Bi-Weekly)

Start Time (HH:MM AM/PM format) *

End Time (HH:MM AM/PM format) *

Total Attending *

Room(s)

Small Meeting Room

Large Meeting Room

Welcome Center

Great Room

Kitchen

Other

Set-Up Style *

Number of 5 Ft. Round Tables *

Number of 8 Ft. Rectangular Tables *

Number of Chairs *

Equipment ($30 Total Charge)

Podium

Flip Chart

Sound System

Projector Screen

Video Projector

Other Needs

Facility Use Guidelines acceptance statement *

PLEASE ENTER THE FULL NAME OF THE PERSON WHO IS ACCEPTING THIS AGREEMENT *