Today's Date *

MM

DD

YYYY

Date of Event *

MM

DD

YYYY

Time of Event (include setup and tear down) *

Hour

Minute

Second

AM PM

What audio needs do you have? (Please check all that apply.)

Speaker/Lecturer

Pre and post event music

Music during event

Live music (Singer/s or band)

What video needs do you have? (Please check all that apply.)

PowerPoint presentation

ProPresenter presentation

Video

Web based video

Movie

Recurring Event? *

Yes

No

Food / Drink Served? *

Yes

No

Will you require use of the Church Kitchen?) *

Yes

No

Do you require room set up? (If so additional fees apply.) *

Yes

No

Sound Technician *

Required if using multimedia/sound system, person approved by Technical Team. Additional fees apply.

Yes (If yes, please complete A/V usage form)

No

Contact Name *

First Name

Last Name

Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Phone *

(###)

###

####

Name *

First Name

Last Name

Date of Event *

MM

DD

YYYY

What audio needs do you have? *

Please check all that apply.

Speaker/Lecturer

Pre and post event music

Music during event

Live music (Singer/s or band)

What video needs do you have? *

Please check all that apply.

PowerPoint presentation

ProPresenter presentation

Video

Web based video

Movie

Electronic Signature *

Please be aware that our A/V system has some very specific requirements, and prior to your event you will need to talk to the person in charge of media to arrange the details of your A/V usage. If you agree to the terms of usage of the Audio/Visual systems at VanChurch, please sign and date here.

First Name

Last Name

Date of signature *

MM

DD

YYYY