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* indicates a required field

2. Name
3. Email Address
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
13. Rental Classification*

    Choose One

    1. Resident
    2. Non-Resident
    3. Non-Profit
    4. Commercial
14. Type of Event (Choose One)*
    -- Select One --Fundraiser/BenefitMeetingPartySeminar/WorkshopWedding/ReceptionYouth Event (12-21 years old)Other
15. Anticipated Attendance *
    -- Select One --0-100101-200201-300301+
16. Preferred Venue
    -- Select One --Pleasant Hill Community CenterPleasant Hill Senior CenterPleasant Hill Teen CenterWinslow Center
18. Requested Date*
    Requested Date
19. Specify Days of Week

    Choose all that apply

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday

    1. Thursday
    2. Friday
    3. Saturday
20. Alternate Date
    Alternate Date
22. Set-Up Time*
    Set-Up Time Start Time

    —

    Set-Up Time End Time
23. Event Time*
    Event Time Start Time

    —

    Event Time End Time
24. Clean-up Time*
    Clean-up Time Start Time

    —

    Clean-up Time End Time
26. Will alcohol be served*

    1. Yes
    2. No
27. Will alcohol be sold?

    1. Yes
    2. No

    If yes, you must obtain a permit from the ABC. 

28. Additional Information
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit