Facility Rental Request Form

Please provide the following contact information:

First Name Last Name

Title Organization

Street Address Street Address (Continued)

City State/Province

Zip/Postal Code Work Phone

Home Phone E-mail

Activity Date: Activity Time:

What activity will you be engaging in?

Which room are you requesting to reserve?

Lyceum Forum Theater

Do you need any special equipment?

Yes No

If so please indicate what you need:

** Must be a KVCC student activity (no outside events or programs) **