Facility Rental Contact Information

Contact Information:

Company Name (if applicable):
Name:
Address:
City:	State:   Zip:
Phone:
Email:

Is the Billing Contact the same as above? Yes
No

If the Billing Contact is different than above, please complete this section.

Company Name (if applicable):
Name:
Address:
City:	State:   Zip:
Phone:
Email:

How did you hear about the History Museum? (Check all that apply) Friend
TV
Radio
Advertisement (print)
Other

What dates are you interested in? Please list primary date and alternative dates.

1. Primary Date         Start Time     End Time  
2. Alternative Date     Start Time     End Time  
3. Alternative Date     Start Time     End Time  

In what space(s) are you interested? (Check all that apply) Outside Amphitheater/Plaza
Boardroom
Education Activity Room
Education Lobby
Mezzanine
Grand Lobby
Odlin Lobby  

What is the size of your group? 1-50
51-100
101-200
200+
Other

What kind of event are you planning? Please offer short description including event title: