Room Request Form

PLEASE NOTE THAT ALL ROOM REQUESTS ARE NOT CONFIRMED UNTIL YOU HEAR BACK FROM US.

Are you a Member of USSB?
YesNo

Select the Type of Event you are Requesting? (Required)

Do you have a USSB Staff Member serving as your Event's Liaison? If so, please indicate that Staff Member's name.

Your Group or Organization's Name (required)

Is your Organization a Non-Profit Organization?
YesNo

Event Title (required)

Brief Event Description (required)
(This description only helps with the booking of your event and does NOT appear in any USSB Publications.

Contact First Name (required)

Contact Last Name (required)

Phone Number

Your Email Address (required)

Mailing Street Address

Mailing City, State, Zip


*(Address Used only to return your security deposit if you become a renter.)

Who should we make out your Security Deposit Refund Check to?
Me PersonallyThe Organization I'm Representing

Will your event take place on a Single Day?
yesno

What is the Date of your Single Day Event? (m/d/yyyy)

If your Event will take place over Multiple Days, please enter the First Date and Last Date below:

First Day of Use?

Last Day of Use?

Describe the Frequency of your Event: (2nd Thursday of the month; Every other Monday; OR the exact dates if there is NOT a pattern of ongoing dates.)

Time of Day You Need the Room (To begin setting up):

Time of Day Your Event Will Begin:

Time Your Event Will End

Time You Will Leave the Room

Which of our room(s) do you want to rent? (see list below; hold CTRL + Click to select multiple rooms)

Are you charging an admission or requesting donations?
YesNo

If you answered YES, please provide details here:

Alcohol Being Served?
YesNo

Food and/or Non-Alcoholic Beverages Being Served?
YesNo

If you answered YES to either Alcohol OR Food being served, please provide details here:

Please Note that the only rooms that have Kitchen access are Parish Hall and Blake Lounge!

If Chairs Needed, How Many?

If Round Tables Needed (66"), How Many? (Additional charges will apply.)

If Rectangular Tables Needed, How Many?

Projector Needed?
YesNo

IF YES - Source of Your Video (DVD, Laptop, Internet, other)

Sound System Needed?
YesNo

IF YES - Source of Sound (DVD, Laptop, iPod, other)

Kitchen Required?
YesNo

For an extra fee, would you like to have USSB provide assistance to:

(USSB requires some events to be Staffed. You will be notified if this is the case before entering into a rental agreement.)

Might your Room Use impact other Room Users or the Church's residential neighbors? (Will you have amplified music, be showing a film, have people coming and going frequently, conducting a drum circle, etc.?) Please let us know of any activity that might "go beyond your room". Thank you very much.)
YesNo

If Yes, please explain:

Comments, Questions, Setup Instructions or Special Requests


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