EmailMe Form - ROOM REQUEST FORM

CONTACT INFORMATION

Contact Name *

First Last

Email *

Phone *

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

Can this number receive texts? *

Yes

No

Do you currently attend Mason UMC?

Yes

No

Ministry or Organization Name Requesting Meeting *

Contact/Organization Address
(Note: if Mason UMC Ministry, leave blank)

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

MEETING DETAILS/INFORMATION

Expected Attendance

Age Group (children/youth/adult)

Please provide date(s) needed for meeting room

Meeting Start Time

HH : MM AM/PM

Meeting End Time

HH : MM AM/PM

Purpose of meeting?

If requesting a specific room, we will do our best to accommodate your request. Please provide your request in the space below.

Room Set-Up (select one)

Room Set-Up Other:
Please provide additional details for room set-up that would be helpful.

Technology Needs (may select multiple)

Window users can select multiple options by holding the Control/Ctrl key and selecting the options with the mouse;
Mac users can select multiple options by clicking Command and selecting the options with the mouse

ORGANIZATION/INDIVIDUAL WAIVER OF LIABILITY (MUMC ministries skip to submit button at the bottom of the form)

Are you a non-profit agency?

Yes

No

Do you have proof of insurance?

Yes

No

Additional Comments/Questions

Waiver of Liability
In consideration of receiving permission from MUMC to enter on the premises, the receipt of permission having been acknowledged, and in further consideration of receiving permission to participate in any activities on the premises of MUMC, receipt of permission being also acknowledged, each of the undersigned (representing all individuals associated with the event being scheduled) release MUMC, its agents, officers, servants and employees of and from any and all liability, claims, demands, actions and causes of action whatsoever, arising or related to any loss, damage, or injury, including death, that may be sustained by any or each of the undersigned, or any property of any or each of the undersigned, while in or on these premises, or en route to or from the premises.

I have read the Building Use Policy provided on the Mason UMC Website. I agree to adhere to its use.

I agree

Yes

No

Name:

Organization: