Facility Request by External Organization/Individual

Requestor's First Name:*

Requestor's Last Name:*

Organization (if applicable):

Phone Number:*

Email Address:*

Street Address:

City:

State:

Select

Zip Code:

Event Details

Please provide us with some additional information about your event.

Type of Event:*

Select

Facility Requested (select all that apply):*

Select

What date(s) will your event be held?*

Please list all requested dates.

What time will your event be held on the above dates?*

Approximately how many participants will be at the event?*

Approximately how many spectators will be at the event?*

Will there by food at the event?*

Yes

Which of the following statements is true for this event?*

The event is restricted to ONLY members of the above-named organization.

The event is open to the public.

Is there a fee for participation in the event?*

Yes

What, if any, additional equipment or setup is required for your event by Mercersburg Academy?*

Is there anything you would like for the office of Summer and External Programs to take into consideration when reviewing your facility request?

Request Submission Date*

Send me a copy of my responses