Date(s) of Building Use:

Start Time: End Time:

Organization / Person(s) Requesting Use of Building:


Contact person / Responsible party:

Contact Telephone: Alt. Phone:

Is this Event Public? Private? Appx # of people attending:

Event type: Wedding Funeral Fund Raiser Other:
If other, please describe.


Rooms Requested:
Sanctuary - Will the Sound System be needed? Yes No
Lounge
Fellowship Hall
Nursery(baby)
Nursery (toddler)
Kitchen (may require Food Handler's License)

Do you have any special needs?

PCUMC USE ONLY:

Approved / Denied

Fees:$____________     Cleaning Deposit Required:$__________

Food handler required

Sound System needed / Sound Tech___________________________

PCUMC Representative______________________________________

Nursery Attendant(s)________________________________________

Other: ____________________________________________________