Facilities Use Request Application
W 5525 Highway 67
Williams
Tel. 262-245-9404
Organization requesting facility use: __________________________________________________
Contact
person: _________________________ Phone
number: __________________________
Email
address: __________________________
Date(s) needed: _________________________
Time(s)
needed: ________________________ Number
of guests (approx.): __________
List rooms/areas you plan to use:
____________________________________________________
________________________________________________________________________________
Purpose of use:
___________________________________________________________________
________________________________________________________________________________________________________________________________________________________________
Name of FCS person who will be present: _____________________________________________
Insurance
Requirement:
Certificate
of insurance is required for all groups requesting use of the building. It must
indicate that
Building
Fee: $ _________ Insurance Requirement
Met: ____Yes
____No ____Pending
(Attach Certificate of Insurance)
These guidelines and fees are subject
to periodic review and changes by the
__________________________________ __________________
Signature
of event supervisor Date
__________________________________ __________________
Administrator’s signature Date