PATRICIA HART LIFELONG LEARNING CENTER

FACILITY RENTAL APPLICATION

DAY/DATE OF EVENT:

RENTAL TIME*: From: am/pm To: am/pm

* Rental time includes set-up and clean-up time.

NUMBER OF GUESTS EXPECTED:

TYPE OF EVENT:
(Wedding/Reception, Birthday party, Church dinner, etc):

APPLICANT:
(Name of company, business, or individual)

CONTACT PERSON:

ADDRESS:

CITY/STATE/ZIP CODE

WORK PHONE: HOME PHONE:

CELL PHONE: FAX NUMBER:

NAME OF PERSON WHO WILL SIGN CONTRACT (if different from contact person):

TITLE: PHONE NUMBER:

EVENT DESCRIPTION: (Use back of sheet if necessary):

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This application will NOT be processed or approved if information is incomplete or inaccurate. No
dates can be contracted without an Approved Facility Rental Application.

This is not a legal contract and is not binding to either the Applicant or the Patricia Hart Center of SCI.
DO NOT make any advance arrangements regarding facility usage until a contract has been fully
executed with The Patricia Hart Center of SCI. This includes disseminating or releasing any
information or publicity of any nature in regard to the event including, but not limited to, the offering
of tickets or reservations.

I hereby confirm that the above is true and correct to the best of my knowledge.

Applicant/Contact Person:

Signature Date

Please return via fax or mail to:

Patricia Hart Lifelong Learning Center

174 Rains Avenue, Nashville, TN 37203
(615) 743-3400 (phone) or (615) 743-3484 (fax)

Accepted by:

Center Director Date

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