Request to facilitate form

Applicant Name or Group Representing:

This address will receive a confirmation email

Phone

Address

Title of Event:

Class or Event is:

One time only Ongoing

Description of Event (be as detailed as possible for marketing purposes):

Upload images (for marketing), please include an image of yourself:

Upload (8MB)

Proposed date(s) of Event:

Proposed time (start and end):

Proposed Class or Event fee:

Scholarship:

Yes: willing to give full or partial scholarship No

Scholarship fee:

Requested UTBR facility space (check all that apply). UTBR reserves the right to make the final decision on space:

Sanctuary Community Room Patio Entire Church Labyrinth

Facility Use Agreement

Please check off each box below to confirm you have read the below:

All reserved areas must be left as found. The renter is responsible for setup, breakdown, and returning furniture to its original position unless arranged with UTBR. No alcoholic beverages or smoking on church property at any time. No food or beverages in the sanctuary. Any damage, or replacement costs due to food/beverage will be the responsibility of the applicant. Damage to the church property caused by the applicant and/or program participants or any person attending the event for which the church was rented, will be charged to the applicant. I acknowledge that this is a class/event being held at UTBR. Marketing includes a news announcement and calendar post on website, slide promo during Sunday services. UTBR is not obligated to announce class or event during Sunday services. UTBR will handle the registration process, collect class fees and provide a class roster of registrants to applicant. Payouts will be processed within 10 business days of last session.

Financial Agreement

Check one:

100% of proceeds to go to Unity of The Blue Ridge 50/50 split of net proceeds Other: The facilitator offsets the cost by handling their own marketing and minimizes the use of Unity of the Blue Ridge staff time. This typically applies to facilitators who have regularly hosted events at UTBR

A nonrefundable deposit must accompany this application to be considered for use of our facility, as reviewing each request requires staff time and attention. $35.00

For Administrative Purposes:

Office Staff: Received by Date Reviewed Approved

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Request to facilitate form

Description

Please Fix the Following