TODAY'S DATE ______________________
1. NAME _________________________________________________________________
2. ORGANIZATION _________________________________________________________
3. ADDRESS ______________________________________________________________
_______________________________________________________________
4. TELEPHONE (HOME) _____________________________________________________
5. TELEPHONE (WORK) _____________________________________________________
6. DATE(S) REQUESTED _____________________________________________________
7. START SET-UP TIME ______________________________________________________
8. END CLEAN-UP TIME ______________________________________________________
9. TYPE OF EVENT __________________________________________________________ _________________________________________________________________________
10. ESTIMATED NUMBER OF GUESTS/ATTENDEES ________________________________
11. FACILITY REQUESTED (CHECK ALL APPLICABLE):
___________ HALF COMMUNITY CENTER (RM 157)
___________ ENTIRE COMMUNITY CENTER (RM 157)
___________ KITCHEN FACILITIES (RM 155)
___________ FIRST FLOOR LOBBY (RM 102)
___________ CONFERENCE ROOM (RM 103)
___________ CONFERENCE ROOM (RM 231) [MEETINGS ONLY]
___________ CONFERENCE ROOM (RM 239) [MEETINGS ONLY]
___________ COUNCIL ROOM (RM 233) [SPECIAL REQUEST, CITY MANAGER APPROVAL REQUIRED]
___________ OUTDOOR TERRACE
12. NUMBER TABLES REQUIRED ____________________________________________
(6 INDIVIDUALS PER TABLE)
13. NUMBER CHAIRS REQUIRED ____________________________________________
14. WILL ALCOHOLIC BEVERAGES BE SERVED? YES _____ NO _____
15. ITEMS/EQUIPMENT REQUESTED: (Sanctioned events/users pay no equipment rentals)
_____ Microphone/PA system No Charge _____ 12” Punch Bowl/Ladle (Qty 2) No Charge
Users renting rooms are charged a rental fee on equipment below
________ Video/PC Projector & Cart (Qty 2) $10each _______ Coffee Pot 55 Cup $5
________ Portable Screen $5 each _______ DVD & TV/PC Monitor 19” $5
________ DVD & TV/PC 42” Monitor on cart $10 ______ Cassette Recorder $5
________ 35 MM slide projector $5 _______ Overhead Projector (not video) $5 each
I HAVE RECEIVED A COPY OF
COMMUNITY CENTER POLICIES AND
PROCEDURES AND AGREE TO ABIDE BY THE SAME.
_______________________________________
Signature of Applicant
16. FEES: TO BE COMPLETED BY COMMUNITY CENTER COORDINATOR (not applicant) AT TIME OF RESERVATION
___________ ROOM RENTAL FEES
___________ EQUIPMENT RENTAL FEES
__$25.00___ OPEN/CLOSE FEE
___________ SALES TAX ________ HOURLY CHARGES (IF REQUIRED)
___________ SUBTOTAL
___________ SENIOR/YOUTH 10% DISCOUNT
___________ SUBTOTAL
___________ STANDARD RESERVATION FEE
___________ ALCOHOL DEPOSIT FEE
___________ TOTAL DEPOSIT FEES
17. ACTUAL COSTS/FEES (TO BE COMPLETED BY COMMUNITY CENTER COORDINATOR UPON COMPLETION OF EVENT)
___________ TOTAL DEPOSIT RECEIVED
___________ ROOM RENTAL FEES
___________ EQUIPMENT RENTAL FEES
___$25.00___ OPEN/CLOSE FEE
___________ HOURLY CHARGES
___________ CLEAN-UP FEES
___________ DAMAGE FEES
___________ TOTAL FEES
___________ AMOUNT OF DEPOSIT REFUNDED
___________ ADDITIONAL CHARGES DUE