Facility Use Request

Name *

First Name

Last Name

Phone *

(###)

###

####

Areas Requesting *

Worship Center ($1000)

Student Center ($500)

Fellowship Hall ($150)

Chapel ($350)

Other

Acknowledgement *

BY CHECKING THIS BOX AND SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ THE MOUNT DOCTRINES AND BELIEFS LISTED BELOW. I RECOGNIZE THAT THE MOUNT RESERVES THE RIGHT TO REFUSE ACCESS TO USE OUR FACILITIES TO THOSE VIOLATING OUR DOCTRINES AND BELIEFS. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.