APPLICATION FOR USE OF FACILITIES

First United Methodist Church 1376 Olive Street Eugene, OR 97401

Office: 541-345-8764 Fax: 541-485-5025

Please fill out this form out completely and return it to the church office.

No space is reserved until the application has been approved by the staff or Trustees of FUMC. After your application has been reviewed, you will be notified.

Date of Application__________ Group/Organization___________________________________________________

Applying for use of: ___________________________________________________________________________

Describe intended usage________________________________________________________________________

_________________________________________________________________________________________________

Usage will be: ___one time only ___weekly ___ monthly ___other ____________________________

Date desired:_______________ Room(s) desired: ____________________________________________________

Start/End Time of event: _____ AM/PM to _____ AM/PM Arrival for Set Up: ____ AM/PM

Building Clear at: ____ AM/PM Estimated number of persons attending: ____

Tables? ____Yes ____No How many? ____Round (seat 7-8) ____Oblong (seat 8-10)

Chairs? ____Yes ____No ___At Tables (How many/table?___) ___Lecture Style ___Center Aisle ___Side Aisles

Podium? ____Yes ____No Sound System? ___Yes ___No Display Table(s)?___Yes ___No How many?___

Please draw desired set up on back of this form.

Admission charged? ____Yes ____No Offering taken? ____Yes____No Registration Fee charged? ___Yes.___No

Proceeds, if any, will be used for:______________________________________________________________________

Reference:________________________________________________________________________________________

Name Address Zip Phone #

Is your group insured? _____ Yes _____No If yes, please provide a copy of the Certificate of Insurance and please add First United Methodist Church as "additionally insured" to the certificate.

Do you believe that the fee for your organization should be reduced? ____Yes ____No

If yes, state reasons on back of this form or attach response to this form.

I agree to be responsible for the conduct of those coming to or participating in the activity for which this application is being made, and for any damage beyond the normal wear and tear which may occur as a result of this activity. I further agree that the church property will be used in accordance with the enclosed copy of Rules and Regulations of the Board of Trustees which I have read and understand.

Name (printed) _____________________________ Phone __________________ Fax # _______________________

Signature ______________________________________

Address _______________________________________

______________________________________________

City Zip

For Office Use Only:

Total Fees: $ __________

Deposit: $ __________

Due: $ __________

Approved By:__________Date: ________