Date of Request:   Reservation Date:   Hours Needed:

Name of non-profit organization:
(Pending approval, a copy of your Tax ID Certificate will be required with your $50 deposit to secure the reservation)

*Affiliations, if any:

Facility Size Needed:

Number of Persons Estimated to Attend (200 max capacity):

*Special Needs, if any (i.e., sound system):

*If you know a member of our congregation, please provide their name:

Your Contact Information Where We Can Reach You

Name:   Phone:   *Email Addr: 

*Optional - All other fields are required.