EmailMe Form - Regional Event Request

Today's Date *

MM / DD / YYYY

Contact Name *

First Last

Contact Email *

Contact Number *

### - ### - ####

ACTIVITY/EVENT

Name Of Activity / Event *

Event Date *

MM / DD / YYYY

Event Start Time *

HH : MM AM/PM

Event End Time *

HH : MM AM/PM

Event location *

Who does the event involve? *

Estimated Attendance *

Purpose of Event *

DEPARTMENT

Ministry/Department Requesting Event *

CHILDCARE

Is childcare needed for event? *

Yes

No

Estimated Attendance (Age 0-preK)

Estimated Attendance (K-6th)

MEDIA / SOUND REQUIREMENTS

Does this event require media/video/creative request? *

Yes

No

If yes, describe what will be needed from creative and production.

SUPPLIES & ITEMS NEEDED

Estimated Cost of Event *

Are there supplies to be purchased for this event? *

Yes

No

If yes, describe what supplies and items will be needed.

EVENT SCHEDULING

Have you checked the calendar to see if it conflicts with another church event? *

Yes

No

Does it conflict with a Community Event in the area? *

Yes

No

Is Security needed for the event? *

Yes

No

Is liability insurance needed for the event? *

Yes

No