Pavilion Reservation

 

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 PATTERSON PARK PAVILION

RESERVATION 

NAME:_______________________________________________________________________ 

ADDRESS:____________________________________________________________________ 

CITY, STATE, ZIP:_____________________________________________________________ 

PHONE:______________________________________________________________________ 

DATE(S) REQUESTED:_________________________________________________________ 

TIME PERIOD:________________________________________________________________ 

ACTIVITY/PURPOSE:__________________________________________________________ 

______________________________________________________________________________ 

______________________________________________________________________________ 

ACCESS TO ELECTRICITY (CIRCLE ONE):         YES           NO 

I HAVE READ AND AGREE TO ABIDE BY THE TERMS STATED IN THE PATTERSON PARK PAVILION FACILITY POLICY. 

______________________________________________________________________________

SIGNATURE                                                                                                 DATE 

******************************************************************************

OFFICE USE ONLY 

APPROVED FOR ______________________________________________________________

                                   DATE(S) AND TIME 

ELECTRICITY             YES             NO              FEE __________  Paid: Cash, Check, MO, CC 

______________________________________________________________________________

SIGNATURE                                                 TITLE                                                 DATE