1912 Center Room Rental Application
APPLICANT INFORMATION:
Organization
Contact Name
What is your organizational status?
$15 per hour (2.5 hr min)
$30 per hour (2.5 hr min)
$60 per hour (2.5 hr min)
E-mail Address
Daytime Phone Number
Evening Phone Number
Billing Address
RENTAL EVENT INFORMATION:
Requested Rental Date(s)
Possible Alternate Date(s)
Room Requested
Set-up Start
Event Start
Event End
Clean-up Done
Time
Purpose of Use
Expected Number of Attendees
PCEI Plate Project
PA System
Screen
Podium
Piano
Special Set-up Equipment
$25 Use Fee
Will you be serving alcohol?
Do you need to use the kitchen?
Is this event open to the public?
Is there a cost for this event?
Website or contact name & number
for more information
EVENT DESCRIPTION:
With your signature, you agree to abide by all the 1912 Center rental policies as seen on our website.
Signature___________________________________________________________________________
Individual or For Profit Organization
Deposit required: $250 check made out to HAI, refundable after event.
Date:
501c3 Non-Profit (provide tax ID number):
Governmental Organization (Tax Exempt- requires a form)
Will you want to borrow dishes?
$20 Fee (use requires a catering permit for $25 from the city clerk)
$10 Partial Use / Catering
$50 Full Use
Please describe your event for us:
May we list it on our calendar?