Room Reservation Request Form

Event Name	*
Contact Person #1	*
Contact #1 Phone	*
Contact #1 Email	*
Contact Person #2	*
Contact #2 Phone	*
Contact #2 Email	*
How did you hear about PWUMC?	*
Number of People Attending Event	*
Is this a PWUMC-sponsored event?	*	Yes No
Childcare may be available for church-sponsored events; please call (816) 741-2972 for more information.
Date of Event	*
Alternate Date
Start Time	*
End Time	*
Setup Time	*
Cleanup Time	*
Please provide a brief description of your event.	*
Equipment Information: Equipment available includes the electronics equipment noted below. These items are only available with advance notice. Please note the equipment you would like to have for your event below.
Equipment Requested	*	None DVD Microphone Television Podium Internet Access
NOTE: The Dining Hall Kitchen is a commercial kitchen, regulated by the Platte County Health Department. If the Dining Hall Kitchen is to be used, 1 of 5 people working in the kitchen must carry a Food Handler's Card that would be recognized by the Platte County Health Department. This would include cards issued by Platte County, Clay County or the Kansas City Health Departments.
Do you or anyone in your group have a Food Handler's Card?	*	Yes No N/A (We are not requesting use of the Dining Hall Kitchen.)
Recurring Event	*	Yes No
If yes, please note recurrence frequency.		Daily Weekly Monthly Other (indicate below)
If this is a recurring event, what is the last date of the recurrence?
Other Frequency
Our standard setup in most classrooms is tables and chairs. If you have a specific setup request, please note it here.
Room Charges: Events not sponsored by PWUMC may incur a building fee. More information about fees will be given to you when your request is processed.
I understand that I will receive an email with the details of my request upon submission. I understand that my reservation is not confirmed until I receive written notification from a PWUMC staff person.
I have read and understand the above statement.	*	Yes