CUMC Usage Request Form  

This form must be completed and submitted along with any required documentation (i.e. certificate of insurance, facility usage guidelies, hold harmless agreement) and applicable fees in order to reserve use of the CUMC facilities.  Deadline for returning the form is seven days prior to the event.  Note:  Even cannot be confirmed until all papers has been turned in and all fees have been paid.

Name of event:  __________________________________________________________________________

Date(s) requested:  _______________________________________________________________________

Name of group:  __________________________________________________________________________

Contact person:  __________________________________  Telephone #:  ____________________________

Address:  _______________________________________________________________________________

Start and end time (including set up and tear down):  ______________________________________________

Approximate total number of participants:  _______________________________________________________

Areas/Equipment requested (some items subject to additional charges):

________  Multipurpose Room

________  Gathering Area

________  Classroom(s)

________  Kitchen

________  China

________  Cutlery

________  Glasses

________  Tables (specify #):  ________

________  Chairs (secify #):  ________

________  Sound equipment:  specify (microphone, TV, etc.):  ______________________________________

________  Hostess @ $10/hr

Signature of contact person________________________________________________

-- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Office use only

Gatekeeper Comittee Member responsible to provide orientation:  ___________________________________

Gatekeeper Committee Member to attend event:  ________________________________________________

Fees paid - amount:  ______________________  Date:  ____________________________

Date placed on master calendar __________________________  Event Canceled (Yes/No):  Date _____________

Deposit Information:  Returned (Yes/No):  Date _________________________

Approved/Not Approved:  Signature of Pastor/Gatekeeper ____________________________  Date ______________

 

 








Carthage United Methodist Church

608 Main Street North

Carthage, TN 37030

615-735-0343

secretary@carthageumc.com

www.carthageumc.com

 

 

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