Name of applicant: ______________________________________________________________

Address: ____________________________ City ____________________ Zip ______________

Name of Group/Organization _____________________________________________________

Is group registered as a tax exempt, non-profit organization? _________(Proof may be required)

Individual responsible and attending on the date of use _________________________________

Telephone (Day) _______________________ (Evening) ___________________________

1. Purpose of group or meeting ____________________________________________________ ______________________________________________________________________________

2. Total number of people expected? __________ Number of children expected? __________

3. Is this activity open to the public? __________ How will event be publicized? __________

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4. Is there a registration/admission or donation required? __________ Amount? __________

5. Will food or drink be served? __________ If yes, describe type: __________________

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6. Are you planning to serve wine/champagne? __________ Will beverages be sold? _________

7. Will music be used during the event? __________ If yes, describe: ________________

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ROOM APPLIED FOR DAY/DATE TIME IN TIME OUT

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Special Equipment: _____ 8' Tables _____ Card Tables _____ Piano _____ P.A. System

List any equipment to be brought in by renting party: ___________________________________

I have read the policies regarding use of the YWCA building and I agree to comply with the terms and conditions and inform participants of the terms and rules. A 50% deposit required in advance. Cancellation Policy: 30 days or more notice - 50% refund. Less than 30 days notice - no refund.

Signature of applicant ____________________________________ Date _____________

==========================FOR OFFICE USE ONLY=======================

Date(s) of use: _____________________ Time in: __________ Time out: __________

Room(s): __________ Fee: __________ Fee: __________ Fee: __________

Personnel: $_____per hour for ___ hours = personnel fee: _____ Maintenance: $_______flat fee

Room Fee Total: __________ Personnel Fee Total: __________ Maintenance Fee: __________

SPECIAL EQUIPMENT: ________________________________________________________