USE  OF FACILITIES FORM

BFA   St. Albans

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Date of Request_____________________                                  Date of Event_____________________

Approved Date______________________                                 Time of Event_____________________

Room/Area_________________________                                 # of Persons Expected ______________

Event______________________________________________________________________________

Organization_________________________________            Contact Person____________________

Non-Profit Organization ________________________             Non-Profit Tax #__________________

Address____________________________________                             Telephone #______________________

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List all equipment needed for your event.  We will notify the persons(s) in charge to have it ready for you.

Last minute requests for additional equipment may not be honored.

Audio-Visual  Equipment

# of Microphones______                  # of Floor Stands______   # of Desk Stands______    Portable P.A.______

Overhead Projector______                Screen______         TV______          VCR______          Other______

Carousel Remote Control______      16 mm. Projector______     Carousel Slide Projector______

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Maintenance/Custodial  Service

# Tables________________           # of Chairs______________            Other ____________________

Rehearsal, Decorating and Clean-Up Arrangements

If you will need access to the room or area you are reserving prior to the time listed above, please indicate what time ___________.  What time will your event be over? _____________

Please note any special room or area arrangement that you will need for your program.

(Catering/refreshment arrangements are the responsibility of the sponsor.)

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The use of any room is not permitted without this form completed in full, including administrative approval.  All requests must be submitted ten (10) working days in advance of facility use.  Please return your completed form to:

Bellows Free Academy

Attn:  Building Use

71  South Main Street

St. Albans, VT  05478

Fax:  802-527-6453

FOR OFFICE USE ONLY

Charges

Rent_______________________                                                                  Lights______________

Custodial___________________                                                                   Other______________

Signature of Requesting Party_______________________________________________________________________________________

Signature of BFA Administrator________________________________________________________________________________

Forward copies to:

 G. Plant               � J. Letourneau    � Library                � M. Dickinson    � N. Caron

 S. Raymond       � S. Tarr � D. Marlow          � J. Grant               � Other (specify)