Facility Use Request

This form is to request space at Burroughs to hold a meeting or program activity. Consideration will based on efforts that align with Burroughs values and ability to advance its mission to support the community. Burroughs does not rent its facility for private parties.
Organization/ Group Name*
Program/ Activity Name
Contact Name*
First Last
Contact Phone*
Contact Email*
Request Information
Date of Requested Use*
MM slash DD slash YYYY
Start Time*

: Hours

Minutes

AM/PM
End Time*

: Hours

Minutes

AM/PM
Minimum number of attendees
Maximum number of attendees*
Is this a new program to Burroughs, please describe how this program/ activity supports the community?
Is this event open to the public?
Is registration required to attend this event?

Request Information