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First Name*

Last Name*

Phone*

Email*

Address*

City*

Postal Code*

Event Title*

Event Details*

Requested Date*

Requested Rental Start Time (24HR Time Clock)*

Requested Rental End Time (24HR Time Clock)*

Number of Guests*

Requested Room to Rent*

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Is this a Military or First Responder Event?

Is this an MDVA Event?

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