Facility Use Request – Michael Memorial Baptist Church

Name (Group or Individual) *

Phone *

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

MMBC Member

MMBC Church Member who will be present/responsible *

Church Member Phone *

Church Member Email Address *

Does the MMBC Member have access to the requested facility with a physical key or key fob? *YesNo

Will you need to be issued a key/fob *YesNo

Start Date *

Month

Day

Year

Start Time *

Hours

Minutes

End Date *

Month

Day

Year

End Time *

Hours

Minutes

What dates and times will you need access to the facility for set up and clean up. *

Please explain the activity to be held. *

Estimated number of Adults Attending? *0 / 4

Estimated number of Children Attending? *0 / 4

How many tables and type of tables will you need? *

Classroom information - How many and location (Youth Building, East Building) *

Please describe the technical assistance you require for your event. *

Please list quantities of any equipment needed above.

Will you need training on how to use the computer/Ipad *YesNo

Will you need training on how to use the sound system *YesNo

Upload any requested files

Signature *

Signature of this form indicates acceptance of all applicable fees and guidelines.