LMCC Rental Request Form
Contact Details
Name of person(s) in charge of Event:
*
First Name
Last Name
Organization
Phone Number:
*
Format: (000) 000-0000.
Email:
*
example@example.com
Event Details
Type of Event:
*
Event Description:
*
Number of Guest(s) Expected:
*
Date of Event (Must be Submitted 2 weeks prior to event):
*
-
Month
-
Day
Year
Date
Room Being Requested
*
Large Room
Middle Room
Kitchenette
Time of Event (Ending no later than 10:00pm:
*
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Total 0.0
Confirmation of the Agreement:
Date of Signature:
*
/
Month
/
Day
Year
Date
Acknowledged, Agreed and Authorized by Renter:
*
Submit Form To
*
Please Select
cdavisclinton@bocahousing.org
Submit
Should be Empty: