DCDS Facilities Rental Request

Upon receipt of your submitted request below, a DCDS staff member will contact you to confirm availability and arrange payment.

Group Name

Contact Name

Preferred Address

City/State

Zip Code

Cell Phone

Preferred Email

Date(s) Requested

Time Requested

Event Type

If Other, please advise type

Approximate # of Attendees

Type of Room Setup

No fee – Standard Classroom/Theater
$100 fee – Change to all classroom or theater

In-house LCD Projector Needed?

Yes
No

DCDS to Co-Sponsor and Give CE Credits?

Yes (CE Accreditation Form Required)
No

Will you be serving food at your event?

Yes
No

If yes, please name the caterer

Please note that all room rental fees will need to be submitted with the Facility Rental Agreement and certificate of liability insurance after confirming date with DCDS staff.

******
FOR OFFICE USE ONLY

Key Pickup Day/Time: ______________________________

Total Amount Due $ Check Enclosed: Check Number:

Credit Card Number: Expiration: ___ / ___ CCV: _______

Payor Name: Date Paid:

DCDS Facilities Rental Request

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