Overnight Stay Application

Name of Organization(required)

Organization Website(required)

Organization Phone Number(required)

Organization Email(required)

Address(required)

City(required)

State(required)

Zip Code(required)

Group Leader Name(required)

Group Leader Address(required)

City(required)

Zip Code(required)

State(required)

Cell Phone/Day Time Phone(required)

Group Leader Email Address(required)

Total Members Staying Male(required)

Total Members Staying Female(required)

Under 18 Years Old Male(required)

Under 18 Years Old Female(required)

Chaperones Male(required)

Chaperones Female(required)

Special Requests

Requested Date of Arrival(required)

Total Night(s) Staying(required)

Dates Staying(required)

Arrival Time(required)

Departure Time(required)

I have read and understand the Statement of Purpose for Memorial Hall and will follow all the rules.(required)

Please sign below. (required)

Do not Fill Below this Line – For Office Use Only

Presented to Council

Motion Approved

Motion Denied

Additional Comments