Requestor's Name*:

Individual or Group Requesting Use (if different from above):

Address*:

City: State: Zip:

Email:

Phone - Day: Evening:

FAX:

Chapel Requested*: Chapel of St. Ignatius Ecumenical Chapel in Campion Multifaith Prayer Room in Campion Immaculate Conception Chapel

Date Requested for Use:

Start Time:
End Time:
Demolition Time:

Expected Attendance:

Purpose of Chapel Use: Mass Liturgy Prayer Service Retreat Tour  Other

Details*: Please provide as much detail as possible so that we can best accommodate your needs.

 

Presider*:

Presider Address and Phone*:

Event Coordinator/Planner*:

Address and Phone*:

Special Requirements (i.e. use of microphone, lighting, etc.):

Status: Current Student (ID# ) Alumnus (Grad. Date )

Trustee Faculty/Staff Other Affiliation

Will you be requesting a donation from participants? Yes No