Event Name

Event Date

If multiple dates, enter multiple dates here. Example: monthly meetings

Time of Event (include setup and tear down)

Requester Name

Requester email address

Requester phone number

Specific rooms(s) requested Specific rooms(s) requested Multi Purpose Room (12) - Lower Level Teaching Kitchen (16) - Upper Level Carpeted Room (40) - Upper Level Upstairs Lobby (20) - Weekends Only

Anticipated number of people attending

Purpose and Benefit of the Event

Do you plan to have food at your event/meeting? Do you plan to have food at your event/meeting? Yes No

Will you be charging a fee for this event? What is the fee?

Event Marketing Event Marketing In office TV Calendar IHC Website IHC Social Media (FB) IHC Newsletter None

Acknowledgement Acknowledgement I understand that as part of my use of the space, I will leave it better than I found it. I will place tables and chairs back in their appropriate places, I will take the trash out, I will replenish restroom supplies and make sure the common areas where my clients and I used are cleaned before I leave.