Date of Request:
Time of Request:
Event Start Date:
Event End Date:
Event Start Time:
Event End Time:
How much time do you need for set-up and tear down:
Event Name:
Room Preferences:
Set up Type:
Childcare needed?
Possible Age Range:
Possible Number:
Contact Person:
Phone:
E-mail:
Audio Visual Needed?
Set Up/Rehearsal Time(s) Start & Finish
Description of Event:
Stage Setting:
Special Microphones
# Wired - Hand held
# Wired - Lapel
# Wired - Choir
# Wireless - Hand held
# Wireless - Lapel
# Wireless - Choir
Sound Notes:
Video Notes:
Lighting:
A / V included:
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