: Room Rental Request - Event Registration

Room Rental Request

INFO:

Please note that this form contains limited capacity items which are sold out. They are displayed grayed out and/or are not selectable.

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When would you like to pay?

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Group Fee:		$0.00
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Billing information

First Name

Last Name

Country

Address

City

State/Province

Zip/Postal

Phone

Applicant Agreement
I represent that I am the person who appears on the application above. I acknowledge and agree to the statements, terms and conditions above, as well as any applicable terms and conditions for this registration, and that by typing my name below and completing this registration form, I am electronically signing the document, which will have the same legal effect as the execution of the document by a written signature and shall be valid evidence of my intent and agreement to be bound.

Applicant Signature
Please enter your full name in the space below.

Please click the button below to finalize your registration.

Registration inquiries:
Mary Molliconi
mary@edgerton.org
(402) 694-4032
208 16th St
Aurora, NE
68818 USA

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Registrant

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Contact Information

Contact First Name

Contact Last Name

Address

Address (line 2)

City

State

Zip

Phone

Mobile Phone

Are you a member

Room Request Information

What is the nature of your event

Please Explain

How many people are you anticipating?

Which space(s) are you interested in?

Theater - Occupancy 50
Classroom - Occupancy 35-40
Basement - Occupancy 60
Basement Classroom - Coming Soon
Zone - Occupancy 100
Strobe Alley
Patio - Occupancy 50

Will you need us to do set-up or clean-up

What time of day will this event take place

What is the time frame?

1st preference for Date of Visit

2nd preference for Date of Visit

Please list specific room needs

Tables (long or round), chairs, projector, etc.

Pricing Information

Pricing for room rentals is based on set-up/clean-up and event time. There is a $100 non-refundable deposit necessary for all events, and the full amount needs to be paid a week before the event.

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