2. Event Name
   

4. LC 278 Rental Application

6. Contact Information

7. Application Date:
   Application Date:
9. First Name*
10. Last Name*
12. Organization (if applicable):
14. Billing Address
16. City
17. State
18. Zip Code
20. Phone Number*
21. Email Address*
23. Event Contact
24. Phone Number
28. Event Name*
29. Event Date*
    Event Date
31. Describe Event
32. List as Private*

    1. Yes
    2. No
34. Check all that apply:

    1. Alcohol Beverages Present
    2. Alcohol Beverages Sold
    3. Licensed Bartender

    1. Special Duty Request
    2. Vendors
35. Number of Guests*
37. Set-up Time
    Set-up Time Start Time

    —

    Set-up Time End Time
38. Event Time
    Event Time Start Time

    —

    Event Time End Time
40. Breakdown/Cleanup Time
    Breakdown/Cleanup Time Start Time

    —

    Breakdown/Cleanup Time End Time
44. Signature

    
    

    __________________________________________________________

45. Date
    Date
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field