Facility Reservation Form Event Leaders Name* First Last Phone*Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Purpose of Event*Possible Dates of Event* Event Start Time* : Hours Minutes AM PM AM/PM Event End Time* : Hours Minutes AM PM AM/PM Time of Event (to include set-up and clean-up)* Please enter the total time needed including any set-up or clean-up time (i.e. 2PM - 6PM)Number of People Expected*Please enter a number from 0 to 100.Do you need additional time for set up and/or clean up?* Yes No Not sure Requested Space* Rollason Community Center The Hake Pavilion What items of support will you need for this event? (Check all that apply)* 60" Round Tables 6' Rectangle Tables Folding Chairs Picnic Tables How many round tables?*How many rectangle tables?*How many folding chairs?*How many picnic tables?*I have read the rental agreement and as the Leader of this event agree to abide by these guidelines.* Yes CAPTCHA