City Contact:
ntact Name:
Phone #:
Alternate Phone #:
Reservation START Date:
Set-Up Start Time:
Event Start Time:
Reservation END Date:
Event End Time:
Clean-Up End Time:
Facility & Space(s) Requested for Rental:
Event Type:
Expected # of Attendees:
# of Chairs:
# of Tables for Guest:
# of Tables for Food:
Set-Up Needs:
A/V Needs:
(at locations specified)
____ Digital Signage/Images ____ outside the room ____ inside the room
____ Other: (please list) ___________________________________________________
Elizabeth Cox at 704-920-4314 [office phone]. Completed forms
can be returned by emailing them to or
by faxing them to (704) 920-4335
All needed doors will be unlocked 15 minutes prior to the set-up time listed above.
Conference, Reception, Birthday, etc.
Reservation Information
Facility Use
All doors will be locked 15 minutes after the set-up end time listed above.
____ Microphone(s) ____ hand-held (#_____needed) ____ lapel (#_____needed)
____ PowerPoint
____ need a laptop ____ bringing your own laptop
Will Your Event Have Food:
Will It Be Catered:
Who Will Cater:
Will Your Event Have a DJ/Band:
Who Will It Be:
Will Alcohol Be Served at Your Event:
Spirituous Liquor:
Permit #:
Name(s) and Telephone Number(s) of Chaperone(s) if applicable:
Any Other Special Needs or Request:
Print Name:
Sign and Date:
I hereby certify that I am the authorized and responsible representative of the petitioning group. The above statements are true to the
best of my knowledge. I have read a copy of the policies governing the use of the facility, and agree that our group will comply with the
and regulations, policies and fee schedule governing the use of the facility. I also agree that all rent and fees shall be paid by the
above due date (14 days before the scheduled event) or confirmed reservation shall become void. I understand that all charges and fees
will be reviewed with me once your reservation is entered; these will also be detailed in my Reservation Permit/Confirmation. I should
not consider my reservation confirmed until I receive my confirmation number.
Limited Special Occasion Permit is Required to serve spirituous liquors (ABC Commission, Raleigh, NC)
You will need to obtain this permit application from the City of Kannapolis, as staff has to sign the application before it is submitted to Raleigh.
Please complete the information requested above and return to
Elizabeth Cox at the information listed at the top of the form.
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