Facilities Use Request Name* First Last Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What is your connection with BBC?*MemberRegular AttenderNeitherName of Organization (if applicable)Purpose of Organization (if applicable)Primary activity in which organization is engaged (if applicable)If applicable, is this organization operated for profit?YesNoIf applicable, is this organization a non-profit religious organization?YesNoHave you contacted any public or commercial facilities (i.e. Convention Center, etc.)?*YesNoReason(s) that these facilities are not appropriate for your proposed activity*What is the purpose and/or nature of the proposed activity?*Is this a one-time event or is it recurring?*One-TimeRecurringIf recurring, how often will it occur?*WeeklyMonthlyEvent Date or Date of First Meeting* Event End Date (if applicable) or Date of Last Meeting Event Start Time Requested* : HH MM AM PM Event End Time Requested* : HH MM AM PM Set Up Time Requested* : HH MM AM PM How many people are expected to attend?*Will your event require multiple rooms?*YesNoWill there be a financial charge to attendees?*YesNoIf yes, how much?*Will anything be sold or distributed in association with the event?*YesNoIf yes, describe*Will you need technical audio/video and/or media support?*YesNoIf yes, what will you need?*Will food be served at the event?*YesNoAnd if yes, what will be the source of the food?*