Facility Usage Form

Name:
 

Email Address:
 

Address:
 

Phone:
  -     

Firm or Institution you are representing (if applicable):
 

List room number(s) you are requesting to use:
 

Name or description of event:  
                        

Date(s) & times room(s) requested:

            Start Time:    - End Time:
  mm   dd    yy

             Start Time:   - End Time:
  mm   dd    yy

       I have read the Facility Use Policy for Members (or the Facilty Use Policy for Non-Members, if applicable) and agree to abide by it. Arrangements for after-hours access to the building must be made in advance during regular office hours.

        If you agree, please enter your initials: