Application for Use

Charles Chrin Community Center of Palmer Township

Enter the requested information, print the form and submit it to the Community Center

Date:

Orgainzation's Name:

Representative's Name:

Address:

City:

State:

Zip Code:

Day Phone:

Pages/Cellar Phone:

Fax Number:

Email Address:

Requirements:

Official Name of Event:

Purpose/Description of Event:

Rooms or Gyms Needed:

Days/Dates Needed:

Set-up Time: Start: Clean-up Time: End:

Event Hours: From: To:

Anticipated Attendance: Participants: Spectators:

Do not write below this line. For office use only