Home Calendar Room Request Form
ROOM REQUEST FORM
Date: (*)
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Contact Information
Event Date: (*)
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Event Start Time (*)
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Event End Time: (*)
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Type Of Event: (*)
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Group Name: (*)
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Room Preference
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Church Affiliation: (*)
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Contact: (*)
Please enter a contact name
Phone: (*)
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E-Mail
Please enter a valid e-mail address
Alt. Phone:
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Address:
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City: (*)
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State: (*)
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Zip Code: (*)
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Group Information:
Number of Attendees:
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Age Range:
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Adult supervision is required for all youth events
Is this a Fund Raising Event?
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Beneficiary:
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Profit or not For Profit Group:
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Ticket Sales:
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Agency:
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Insurance Carrier:
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A copy must be supplied to the church 2-weeks prior to the event. See Rental Agreement for details.
Insurance Agency Contact:
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Phone Number:
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Policy Number
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Room Requirements:

*GROUPS WILL SET-UP AND TAKE DOWN UNLESS PREVIOUSLY NEGOTIATED
# of people:
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Room Set-up:
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A/V Equipment:
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Refreshments:
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All utensils used by the group are to be washed and placed back in the receptacles in which they are provided as outlined in the Rental Agreement. Reminder: Epworth is a “GREEN FACILITY”, we ask that no paper, plastic or Styrofoam products be brought into the facilities.

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