UNITED WAY COMMUNITY ROOM REQUEST

Name(Required)

First Last

Organization(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Event Title(Required)

Event Description(Required)

Event Date(Required)

Event START Time(Required)

Please choose a time between 8:30 am – 4:30 pm Monday-Friday. Event start time should include setup.

Event END Time

Please choose a time between 8:30 am – 4:30 pm Monday-Friday. Event end time should include cleanup.

Number of Expected Guests(Required)

Will you need access to our screen for presenting?(Required)

Yes, please

No, thank you

I understand and agree that my image may be used by United Way.(Required)

I willingly and voluntarily give my consent to share my image. By checking the box, I hereby grant permission to United Way of the Chattahoochee Valley (UWCV) to use any photographs in any and all UWCV printed and digital materials, presentations, or media releases without further consideration, and I acknowledge UWCV’s right to crop or edit such materials at its discretion. I also acknowledge that UWCV may choose not to use my image at this time but may do so at its own discretion at a later date. I understand that my image may be shared publicly and that my name may be associated with it. I release UWCV from any liability arising from the use or publication of my image. I agree that I will not receive any monetary compensation or other remuneration for the use of my image by UWCV.

I agree

The Community Room will be returned to its original state following the close of the event. Trash will be placed in the proper receptacles, tables and chairs will be returned to original places, and all guest supplies will be collected and removed. United Way will not be required or liable to dispose of large quantities of unwanted pamphlets, handouts or give-a-ways. Guests will refrain from altering any United Way equipment. The use of the United Way employee breakroom (including any refrigerator, microwave, etc.) is prohibited. Guests using the Community Room during regular business hours will keep noise to a minimum.

I understand and agree I will be responsible for setup and cleanup of the Community Room.(Required)

I agree

I understand and agree I will be responsible for providing food and drinks needed.(Required)

I agree

I understand and agree this is a request under review until I receive confirmation of approval.(Required)

I agree

Phone

This field is for validation purposes and should be left unchanged.

1005 Front Avenue Columbus, GA 31901
PO Box 1157 Columbus, GA 31902
706-327-3255 (Phone) 678-619-0387 (Fax)
EWELLS@UNITEDCV.ORG (EMAIL)

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UNITED WAY COMMUNITY ROOM REQUEST

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