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Facility Usage Request Form

Name of Contact:
Phone:
Email:
Organization:
Mission of Group:
Building you are requesting: 1st Choice
2nd Choice
Date/time of use:
How many people do you expect at the event:
Are you willing to use another building/room: Yes
No
Purpose of the meeting:
Activities to take place in building:
Other information:
Will there be use of the stage area? Yes
No
How will the stage be used?
Will there be any use of Madison Fumc Av Equipment? Yes
No
Will you use microphones? If yes, how many? Yes
No
Ipod? Yes
No
Powerpoint? Yes
No
DVD? Yes
No
CD? Yes
No
Jump Drive? Yes
No
SlideShow? Yes
No