Gamble Rogers Middle School Facilities Request Form

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1.	Your Full Name*

2.	Your Email Address*

3.	Club / Group Name*

4.	Type of activity*

5.	Number of people anticipated*

6.	Date(s) facility needed*

7.	Beginning time*

8.	End time*

Facility Requested*
Select one

	Cafeteria
	Media Center Conference Room
	Gym Sports Areas
	Auditorium
	Guidance Office
	Principal's Conference Room
	Classroom

10.	Will this be a school sponsored event?*
	Yes No

	Furniture or equipment needed

11.	Will you need a microphone?*
	Yes No

12.	Will you need a Podium?*
	Yes No

13.	Will you need media equipment (i.e. PC projector)?*
	Yes No

14.	How many tables will be needed?

15.	How many chairs will be needed?

Done