WPBC Meeting Room Use Request Form

Account	Today’s Date		
	Organization		
	Address		
	Address		
	City			State			Zip		
	Home Phone			Work Phone							Ext 	
Contact	Name		
	Telephone			Fax		
	Email			
Org	1. Is either a business or organization sponsoring this rental?		Yes  		No
-	Is your organization a registered 501(c)(3) not-for profit organization?		 	Yes  		No
-	Is your organization a church?				Yes  		No
-	Is your organization an educational institution?			 	Yes  		No
-	Is your organization a governmental agency?				Yes  		No	 
	2.  Is a private individual sponsoring this rental?		Yes  		No
General Use	Have you booked a room at WPBC before?	 	Yes  		No
	Is this booking a “third-party rental (i.e., are you renting for someone else)?”           		Yes  		No
	Is your event open to the public?			Yes  		No
	Will you collect admissions, dues, donations, or fees?		Yes  		No
	Is your event a fundraiser?			Yes  		No
	Will you be advertising your event?			Yes  		No
	Are you requesting a fee waiver?			Yes  		No 
	
Plaza Room	Will your event be catered?			Yes  		No
       Use	Will you be serving food and/or drink?		Yes  		No
	Will alcohol be served?		 	Yes  		No
	Will red dye drinks (including red wine) be served?		Yes  		No
		Will you need extra time to decorate (setup & take down) 			        _	_Yes  	   ____No
		
Sanctuary	Will you need extra time to decorate (setup & take down)?		Yes  		No
       Use	Will you being renting use of the Organ or Piano?		Yes  		No
	
*  Smoking is only allowed outside of the building .  

RENTAL RATES, -2011-2012  SEASON
Room Type	Capacity**	Rental Rates*	
		Member	Affiliated  
	Non-Affiliated/
General public	
Sanctuary	100	No charge	$63/hr	$105/hr	
Musical instruments in sanctuary --piano or organ	N/A	$158/use	$158/use	$158/use	
Sound System use in Sanctuary	N/A	No charge	$53/use	$53/use	
Plaza Room
(5 sections)	100	No charge	$32/hr	$53/hr	
 (3 sections)	50	No charge	$16/hr	$27/hr	
Kitchen	5	No charge	$19/use	$32/use	
Outside electrical outlet	N/A	No charge	$19/use
Summer Pass - $90	$32/use
Summer Pass - $150	
Small Meeting Rooms (Upstairs)	10	No charge	$16/hr	$27/hr	

	Location 	Room Type 	Rental Date	Rental Time	No. Persons
Room Booking 1										
	Room Use		
	Additional Information		
	Alternate Dates/Times		
	Location 	Room Type 	Rental Date	Rental Time	Persons
Room Booking 2											
	Room Use		
	Additional Information		
	Alternate Dates/Times		
	Location 	Room Type 	Rental Date	Rental Time	Persons
Room Booking 3											
	Room Use		
	Additional Information		
	Alternate Dates/Times		
(Attach additional sheets for more booking requests)

WPBC Use Only
	Date Received 		Received by 	
Accepted 		Denied 		Reason 					
	HH ID			Rsv. No. 		Date Acknowledged 	

	Location 	Room Type 	Rental Date	Rental Time	Persons
Room Booking										
	Room Use		
	Additional Information		
	Alternate Dates/Times		
	Location 	Room Type 	Rental Date	Rental Time	Persons
Room Booking										
	Room Use		
	Additional Information		
	Alternate Dates/Times		
	Location 	Room Type 	Rental Date	Rental Time	Persons
Room Booking										
	Room Use		
	Additional Information		
	Alternate Dates/Times		
	Location 	Room Type 	Rental Date	Rental Time	Persons
Room Booking										
	Room Use		
	Additional Information		
	Alternate Dates/Times		
	Location 	Room Type 	Rental Date	Rental Time	Persons
Room Booking										
	Room Use		
	Additional Information		
	Alternate Dates/Times		

	Location 	Room Type 	Rental Date	Rental Time	Persons
Room Booking										
	Room Use		
	Additional Information		
	Alternate Dates/Times		
	Location 	Room Type 	Rental Date	Rental Time	Persons
Room Booking										
	Room Use		
	Additional Information		
	Alternate Dates/Times		
	Location 	Room Type 	Rental Date	Rental Time	Persons
Room Booking										
	Room Use		
	Additional Information		
	Alternate Dates/Times		
	Location 	Room Type 	Rental Date	Rental Time	Persons
Room Booking										
	Room Use		
	Additional Information		
	Alternate Dates/Times		
	Location 	Room Type 	Rental Date	Rental Time	Persons
Room Booking										
	Room Use		
	Additional Information		
	Alternate Dates/Times		
	(Attach additional sheets for more booking requests)