jcccnc / facility / rental request form

* Type of Renter
 Organization/Company Name
* First Name
 * Last Name
* Phone Number
( ) - 		Email Address
* Requested Date
 * Requested Time
* Requested Room
 Time needed (includ. setup & clean-up)
hrs.
* Rental Purpose
 Number of Chairs & Tables Required
chairs
tables
Additional equipment needed
PA system (w/speakers)
Podium
Video projector
Slide projector 		Television
DVD player
VCR
Projection screen
Please indicate quantities for the following additional equipment:
Risers (up to 12)
Hot water boiler (up to 2)		 Microphone (up to 4)
Microphone stand (up to 4)
Notes/Additional Requests
*Indicates required fields