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, . <br /> East Pasco Sevent6-Day Adventist�Churcb <br /> '1333 Dairy Road,Zephyrhilts;FL 33540 <br /> 813.782.2000 pho�e 813.?,82.4000 fasc epsdachwch@tas�iPabaY.nr.cam <br /> Reques�for Use �f Church_Facitity� <br /> D8t�Of RC�1I8St .Taill2aTy 11,201Ei V�..t ���� I <br /> 1� <br /> Name of(Jtt,gr�s�z�atian FHZ �Q,�� :����� <br /> GL_. ���- ��3 �1�� <br /> � <br /> Name af Contact Perso�n Jane Freema�n <br /> Phone 8�.�8�.�0$2 Fa�r Exnail Jane.Freaman@ahss.org <br /> Dates Requested for Use Fehriiaiyl5,2ax6 and Mam.1i i5,2oi6(Heart E�So and <br /> I.,�dies'Who Lunch) �ctt�p as outlined on th�hack;�.i�;e. �111 s�aer rtiusl 1x:ba��k tu it's <br /> , r�ri�;in�rl�c:itin�;l��Tlnirsdu}'.�t 5.0o p.ni.;spccific:�lly i.t�c I�cllcnr:;hi��Ilalt and Glassrcxam <br /> ��;. <br /> Rc►oYns requested <br /> � Satictuar�� {Sersta izp tc�:3cu��a€�ople/53So per clay7 S g;;t�.r�t� <br /> 1..� ('1�;��xyl (5�•.�t:+ui�2u t5u�,e�c,plr/Si�ca�>cr dzit•} S i5tt.uc� <br /> � tlnsstci{�ti�s �{S�ai:�up to�{��pt:��p3e j S�o�rcr c3c��')x;; S 2C)O.t)n <br /> Incltide�r•l:.i;:4r�ic�m's,�1,5,6,7.at�d#3 <br /> � Ci�ssraom 2(SeaL4 up to 4o peopte f Sqb ger day) $ . <br /> 0 Classmom g(Seats ap i'o 4o peaple J,$4o per day) 3 <br /> ❑ OYlier Room S <br /> Equipment needed . <br /> ❑ 5��1 ti�r uf�lalrli�,trnd rh;rirs bti�R��trtinp.;Ui�,�ir�ir.�tina� ($50) Ye:a � No <br /> ❑ Set up of'Lables anci chairs_by East"Pasco SDA Churrh $ <br /> - � - - 0 �Ntiint:er.af table�nee�ed _ _ . - - - - -- -- - -- -- - � - <br /> 0 Nu�l�er o€chairs needed <br /> 0 :4udio/V`�sua1 Eqaiprnent Us�1Fee � �jA <br /> 0 il+ionitoring and t�gerating Auclio/V`�sual {$ia.oaJ#�r) $ N/�. , <br /> � tl�tc3ifs ft�i:�ti�l ec�uipa�iz�ti fitrt=�ietfi -projcrt�r�ntti st�rc�>ns,m'tkcs SSc�.u�a <br /> t.,1 C)thej••-.Ic►nit��rial C'it��ini�Ir 51oo.qu <br /> C� Tatt�i I3al�nc•c I�urt� (includin�;w��;��di;�cnunt nri rental ritr) ��,�a2.oc� <br /> dnte <br /> . � . . �n..� ��-��- `l�l�� ' <br /> ��� �t.,�.., . .. <br /> D�te Jannary u,2oi� <br /> Ad�inistrative A.utharflzation <br /> 'Fhi�t3neti�uet�t��•i11,�r�e��3s hotl��t���r Cv�f irmr.eitit�rt�ofReserss�tzon a�acl�=cu�r <br /> Ireua�eee,f+orP,ayanent, 4'lca5c}�roce��s;��aur��iyiuctli ta arri�-e in«ur affic e fi,-��clav� <br /> pt•ior tc�yc�ursc)���t�n]c�cl c°��ent. Ch�cks shr�ald b��ri38K�C 1Ja)'ablC tcy t}l7!1:1'Sl)r'1 C.hurc�ly <br /> �inci mail��d trs i333 l�air,•Rrr<x�,7.cpla}�rl�iIIs, }�I.3:�54U. Thank��ou. <br /> � <br /> f <br /> i <br />