Building Use

Name: *

First Name

Last Name

Setup Time:

Hour

Minute

Second

AM PM

Event Start Time:

Hour

Minute

Second

AM PM

Event End Time:

Hour

Minute

Second

AM PM

Tear Down Time:

Hour

Minute

Second

AM PM

Home Phone:

(###)

###

####

Cell Phone:

(###)

###

####

East Hills Campus:

1405 Burcham St. Kelso Wa, 98626

Main Hall

Community Room

Kitchen

Office Space

Resources Requested:

(may involve additional fees and arrangements)

Childcare

Audio/Visual

Tables

Chairs

Linens

Dishes

Coffee/punch services

Paper goods

Is a room requested for childcare?

yes

no

I have read and agree to the Building Use Policy (posted at the top of this page) *

yes