UUCMP Facility Use Request

Please fill out this form and click submit.

Request Prepared and Submitted By:

Requestor Name

*

Requestor Email

Requestor Phone

*

Is that a Mobile number (text-capable)?

*

Please select one option.

Yes No

Requestor Mailing Address

*

Event Contact / Coordinator (if different from Requestor)

Contact Name

Contact Email

Contact Phone

Is that a Mobile number (text-capable)?

Please select one option.

Yes No Not sure

Facility Use Details

Event Title

*

Event Description

*

Event Start Date

*

Event Start Time

*

Event End Date

*

Event End Time

*

Recurring Event? Describe schedule desired:

Facility Space(s) Requested (check all that apply)

*

Please select all that apply.

Sanctuary Welcome Hall Large Conference (Fireplace) Room Small Conference Room Kitchen Exterior Grounds Vehicle Parking

Maximum Number of People Expected Simultaneously

*

Maximum Number of Parked Vehicles Expected Simultaneously

*

Will Audio/Visual or Internet Services be Needed?

*

Please select one option.

Yes No

Special Preparation Required (e.g., furniture setup)

Setup Assistance from UUCMP?

*

Please select one option.

Yes No N/A

UUCMP Technical Support During Event?

*

Please select one option.

Yes No

If Yes, please describe type & timing:

Food or Beverage Consumption Planned?

*

Please select one option.

Yes No

Kitchen Appliances / Utensils / Dishware Needed?

*

Please select one option.

Yes No

Takedown/Cleanup by UUCMP?

*

Please select one option.

Yes No N/A

Donation Amount to UUCMP

*

Event Liability Insurance Coverage

UUCMP-Sponsored Event?

Please select all that apply.

Yes - Extra Insurance N/A

Policy Held By (Insured)

Policy / Rider Issued By (Insurer)

Policy Number

Coverage Limit

Description

Please fill out this form and click submit.

Please Fix the Following

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