2. Requested Date & Time*
   Requested Date & Time Start Date

   Requested Date & Time Start Time

   —

   Requested Date & Time End Date

   Requested Date & Time End Time
3. Alternate Date & Time
   Alternate Date & Time Start Date

   Alternate Date & Time Start Time

   —

   Alternate Date & Time End Date

   Alternate Date & Time End Time
5. Number of Guests*
6. Type of Event*
8. Will there by alcohol? *

   1. Yes
   2. No
9. How many hours will you need the facility?*
11. Contact Name*
12. Organization
14. Address1*
16. Address2
18. City*
19. State*
20. Zip*
22. Telephone*
24. Email*
26. Thank you for your interest in the Kaufman Civic Center. Our staff will contact you to go over your rental inquiry. Please indicate how you prefer to be contacted:

    1. Email
    2. Phone
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field