Name : *

Email : *

Phone : * Characters Left

Address : * Characters Left

Date & Time of Event : * Characters Left

What time will setup begin and what time will clean up end? : * Characters Left

Type of Event : * Characters Left

# of Guests Expected : * Characters Left

Will alcohol be served at your event? : * No Yes, will be given away. Yes, will be sold Yes, and includes hard liquor

Is this event for a non-profit organization? : * Yes No

Are you a current museum member? : * Yes No

Are you planning on coming in the day before to set-up? : * Yes No

Will you be holding your event in any additional areas? : * No, just the Salsbury Room/Library area Yes

If you answered YES, to additional event areas, where? : * Characters Left

Will you need an area to prepare food? : * No Refrigerator (no freezer) Kitchen area Studio B (if available)

Will you need a space for changing? : * Yes No

Do you plan on using our AV equipment? NOTE: Does not include a microphone. : * Yes No Maybe

Additional details or special requests : * Characters Left

I have read, understand, and will follow the MacNider Rental Policies. : *

Signature of Responsible Party : * Characters Left