SB Southampton Facilities Request Form

First Name

Last Name

Your Organization

Address 1

City

State

Zip Code

Email address

Telephone

Type of event

Proposed event date(s)

If Other, please list here:

Event duration (hours, days, etc)

Number of people expected

Additional comments (tech needs, etc)

I understand that if my event is approved I will need to provide insurance in the amount of two million ($2,000,000) general liability and two million ($2,000,000) aggregate.

yes
No

I/We are a registered non-profit organization

yes
no

My event includes minors (under 17 years age).

yes
no