Last Revised on 1/2017
Form received by:_______________________________
Reservation completed on:________________________ Reservation confirmation number: _________________
Facility Room Request Form
Event /
Activity Name: ____________________________________________________________________
Date(s) requested:_______________ Prefered time: _______________am/pm to ________________am/pm
Set-up completed by:___________________ am/pm Tear - down completed by: ________________ am/pm
Preferred location(s): First choice_________________________ Second choice:________________________
Will you be charging fees for this event? Yes______ No______ (Please check one)
Is your event on a weekend? Yes______ No______ (Please check one)
Please select a room set-up:
____ U-shape (Horse shoe) _____ Hollow Square / Rectangle _____T-pod (6 people)
____ Square Pods (4-8 people) _____Classroom _____Theatre
____ Banquet _____Other (if other, please attach a diagram)
Total number of tables requested______Rounds ______6’Rectangular _____5’Rectangular
Total number of chairs requested:__________
Please
mark which, if any, audio / visual equipment or technology support you will require for your event:
____ Projector _____Internet Access ____Microphone - ___Wireless
____ Projector Screen _____Smart Board (available in classrooms only)
____ Podium _____Stage Other:_________________________
If your event will be having refreshments, do you anticipate extra support from custodial during and /or after
event? Yes_____ No______ (Please check one)
Reason______________________________________________________________________________________
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