Impact Lock-In

CCC Facility Use Request

Your Name : 
Today's date : 
Check here if this is a one time use.
Date of one time use : 
Set Up Time : 
Start Time of Event : 
Check here if this is a recurring use.
Start Date : 
End Date : 
Day of the Week: : 
Indicate occurrence (weekly, monthly, etc) : 
Name of Event : 
Sponsoring Organization : 
Contact Name : 
Contact Phone : 
Room or Space Requested : 
Start Time of Event : 
End Time : 
Estimated number of attendees : 
If you need chairs, how many?
If you need tables, how many?
 Check here if you will need the piano.
 Check here if you will need to use any sound/and or equipment from the church.
 Television
 DVD player
 CD player
 Video Projector
Do you need microphones? Indicate what kind: Lapel, handheld, wireless, etc.
Please indicate any special instructions for this event.