Facilities Use Request

Please fill out this form if you would like to use our facilities.

Your name *

Email address *

Phone number *

Address *

What is your connection with PBC? *

Name of Organization (if applicable)

Purpose of Organization (if applicable)

Primary activity in which organization is engaged (if applicable)

If applicable, is this organization operated for profit?

If applicable, is this organization a non-profit religious organization?

What is the purpose and/or nature of the proposed activity? *

Is this a one-time event or is it recurring? *

Event Date or Date of First Meeting *

Event End Date (if applicable) or Date of Last Meeting

Event Start Time Requested *

Event End Time Requested *

Set Up Time Requested *

How would you like the room(s) to be arranged? *

Will you need tables, chairs, media, in what arrangement, etc.

How many people are expected to attend? *

Will your event require multiple rooms? *

Will there be a financial charge to attendees? *

Will anything be sold or distributed in association with the event? *

Will you need technical audio/video and/or media support? *

Will food be served at the event? *

Are there any other special notes regarding this event?

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