Renter Information:
Name:_______________________________________________________________________
Address (City/State/Zip): _________________________________________________________
Contact Person: Phone #: ________________________________________________________
Type of Event: _________________________________________________________________
Date & Time of Event: No. of People Attending: ________________________________________
Specify set up & equipment needs: (set up & clean up times, chairs, tables, etc.)
____________________________________________________________________________
____________________________________________________________________________
List all rehearsal dates/times: ____________________________________________________
Fees: To be completed by MKAC Staff only
Rental Fee: $____________________________ Paid:___________________________
Facilities Monitor Fee: $____________________ Date:___________________________
Security Deposit: $________________________ Refunded:_______________________
(Refundable upon inspection approval)Non-refundable Cleaning Fee $______________
MKAC Facilities Monitor: ___________________
* * * * *
I have read, understand, and agree to the terms and conditions as listed in the MKAC Terms and Conditions Statement.
Renter Signature:___________________________________________________ Date: __________
MKAC Representative Signature: _______________________________________ Date: __________
1910 East 15 th Avenue · Eugene, Oregon 97403 · Phone: (541) 345-1571
Fax: (541) 345-6248 · www.mkartcenter.org · mkart@efn.org