Facility Request Form
First Name
*
Please enter your First Name
Last Name
*
Please enter your Last Name
E-mail
*
Please enter email address/username
Phone
Please enter your phone
Event Name
*
Please enter your Event Name
Event Description
*
Please enter your Event Name
Is this Event Offsite/Virtual?
OffsiteLocation
Virtual Meeting Link
Event Date
*
Begin Setup
Start Time
*
End Time
*
End Teardown
Event Recurrence Rules
Recurrence
None
Daily
Weekly
Monthly
Yearly
Custom
Recurrence Rules
Every
days(s)
*
Every Weekday
Recur Every
week(s) on:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Recur every
month(s) on:
Day
The
First
Second
Third
Fourth
Fifth
Last
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Recur every
years(s)
On
January
February
March
April
May
June
July
August
September
October
November
December
First
Second
Third
Fourth
Fifth
Last
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
of
January
February
March
April
May
June
July
August
September
October
November
December
Recurrence dates:
End Event after
occurrences.
OR
End After Date
Location
*
APC
View Location Conflicts
Public?
Public Notes
Public Link
Number of People
*
Please indicate any special room set ups or AV requests for your event:
Is anyone under 18 years old participating in this event? (If yes, 2 Adult background checks will be required)
Yes
Is the group requesting space registered as a 501c3 non-profit organization?
*
Yes
No
Additional Contact Person/Co-Leader (Name, email and phone number)
Please attach your organization's COI (Certificate of Insurance)
Read the Facility Use Policy, then attach page 16 signed and dated. The policy can be found on the APC website, under quick links.
*
Real Person Verification