FACILITIES Please fill out this form to apply for MPC facility use.Applications must be sent at least a month in advance of requested date. Group Name * Requested Start Date * MM DD YYYY Requested End Date * MM DD YYYY Start Time * Hour Minute Second AM PM End Time * Hour Minute Second AM PM Setup Start Time * Hour Minute Second AM PM Setup End Time * Hour Minute Second AM PM Tear Down Start Time * Hour Minute Second AM PM Tear Down End Time * Hour Minute Second AM PM Meeting Frequency Weekly, twice a month, etc. Group Size * Purpose of Group * Does this group have non-profit status? * Yes No Group Description * Website * http:// Will you require tables and chairs? * Please specify how many of each. An additional fee is assessed for setup, use and teardown of tables and chairs. Will you require use of AV equipment? * Please specify what your AV needs are. An additional fee is assessed for setup, use and teardown of AV equipment. Contact Person * First Name Last Name Phone * (###) ### #### Email * Requested Facility Area(s) * Signature * Please type your full name and today's date. Thank you! Upload Certificate of Liability Insurance (Required)
