Contact Name (required) name of person entering request

    Name of Requesting Ministry/Group/Organization (required)

    Date Submitted (required)

    Church Affiliation (required)

    FBHP MemberNon-Member

    E-mail Address (required)

    Cell Phone Number(xxx) xxx-xxxx:

    Work/Home Phone Number: (xxx) xxx-xxxx

    Fax Number: (xxx) xxx-xxxx

    Type of Event: (Select One)

    Other:

    Date of Event Requested (mm/dd/yyyy)

    Time of Event Requested: (hour:minutes AM/PM)

    Timeline of Event from Setup to Cleanup

    Number of People Estimated or Expected

    Related Organization and/or Sponsor

    IRS 501 (c) Status
       

    Does Organization have Liability Insurance that Covers Event?

    YesNo

    What are required for this Event? (Select all that apply):

    Audio RequiredVideo RequiredTechnical Assistance RequiredCopier/Fax MachinesTelephone Line Access

    Will there be a charge or admission to attend the Event? (required)

    YesNo

    Note: Tickets must be sold prior to the Event. No Tickets can be sold at the Door.

    Will there be an Offering Collected? (required)

    YesNo

    Is Event for Members or Open to the Public? (required)

    MembersPublic