Activity Request Form

Please fill out the information on this screen as completely as possible so your request can be processed in a timely manner. Note that fields marked with an "*" are required.

Title of Event*

Event Description*
(text to be displayed on website)

Group/Ministry Sponsor*

If "Other" selected above, who is the event sponsor?

Contact Person Name*

Your Name (if different)

Contact Person Phone*

Contact Person E-Mail*

Event Date*

Event Time*

Start Time:
End Time:

Time in Building
(including setup & clean-up)

Start Time:
End Time:

Recurring event for this day & time?

Ending Date if Recurring Event

Facilities Requested*

Preschool Building - Room #	Auditorium
BSM Christian Challenge (Bldg 2)	Kitchen, Auditorium
College & Career (Bldg 3)	East Wing, Auditorium
East Room, Building #4	West Wing, Auditorium
West Room, Building #4	Front Lawn
Children's Building (Bldg 5)	Other
Youth Building (Bldg 6)
Building #8

If "Other" selected above, what building/facility is requested?

Keys Borrowed

Set-up requested?

Clean-up requested?

NOTE: Each group is responsible for their own set-up/clean-up unless there is a special need.

Equipment Needed*

Sound System/Microphone	DVD/VCR Projector
Computer/Powerpoint	TV/VCR
Tables/Chairs	Portable TV/VCR (27")
None

NOTE: A trained audio visual technician must be used if you use the audio visual equipment for any activity. Contact the office for a list of trained technicians.

Name of Technician You Will be Using (If Applicable)

All Activity Requests must be coordinated and approved before final authorization of activity or event.