Facility Request Form • Life Church

First Name

Last Name

Email Address

Mobile Number

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Please describe your event

Date of Event

Tip: If you have multiple dates - please select the Multiple Dates option below

Multiple Dates

1st Multiple Date

2nd Multiple Date

3rd Multiple Date

4th Multiple Date

5th Multiple Date

I am requesting more than 5 dates

Tip: Please input all the dates you would like to request. This is not a guarantee.

Time of Event

5:00 PM - 6:30 PM

6:30 PM - 8:00 PM

8:00 PM - 9:00 PM

Other

Other Time

Will you require any equipment?

I understand that if my group is using the gym and is the last one scheduled for the week, we will be responsible for setting up the chairs for Sunday service. *

Yes

I do not want to be responsible for setting up chairs for Sunday Service

I have read the rules and requirements found in the Facility Request Form *

Yes

No - Please Send me the form