Small Group Room Request Form Small Group Name*Leader(s) Name(s)*Email* Home PhoneCell PhoneDay of Group Meetings*Select OneSundayMondayTuesdayWednesdayThursdayFridaySaturdayFrequency*Select OneWeeklyEvery Two WeeksOtherIf Other, please explainDate of First Meeting* Date of Last Meeting* Meeting Start Time*Meeting End Time*Number of People Expected*Room(s) Required*Please check off the room(s) you will need. Classroom Multipurpose Room Kitchen Other If Other, please explainSpecify Room Number if You Have a PreferenceAll efforts will be made to accommodate your request, however, please note rooms are subject to availability and will be assigned on a first-come, first-served basis. Furniture and Other Items RequiredPlease specify what you will need for each room and who will be responsible for the set up and tear down of furniture. Please fill out the Room Set Up Schematic. Round Tables Rectangular Tables Chairs Number of Round Tables NeededNumber of Rectangular Tables NeededNumber of Chairs NeededTechnology RequiredPlease specify technology needed. TV and DVD Player CD Player Other Right Now Media Access If Other, please explain MiscellaneousEach Small Group is required to provide their own paper products. Will there be food and/or refreshments during the meeting?YesNoIf yes, please indicate the person or persons designated for clean up.Name of person responsible for locking up of building or area after meeting if applicable. First Last *Required Field