Facility Use Form Date of ApplicationOrganizationApplicant NameAddressPhone(Required)Email(Required)Date of EventStart TimeEnd TImeFee Exempt Group Classification School Groups and Affiliated School Groups Community Based Non-Profit 501 (c) (3) Organizations (Attach Copy to Application) Townships of Lehman, Ross, Lake, Jackson, Noxen, and Harveys Lake Borough Attach Community Based Non-Profit 501 (c) (3) OrganizationsMax. file size: 125 MB.Building(s) or Grounds RequestedArea of Building RequestedSpecific Purpose of RequestInsurance Company (Copy of Policy Must Be Attached to Application)Policy #Attach Insurance PolicyMax. file size: 125 MB.Admission Fee for EventAnticipated Number of AttendeesCheck the Corresponding for Additional Equipment Needed. Additional Charges May Apply. Sound System Lighting Media Technology Athletics Equipment Concessions Scoreboard Seating Kitchen Other (Please Specify Below) Description of Other Equipment Needed Δ
