Chemeketa Brooks Facility Use Request

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Complete this form to request the use of the Chemeketa Brooks Center facilities at 4910 Brooklake Rd NE, Brooks OR 97305. Submission of this form does not reserve the facility, a Facility Use Agreement would need to be completed for approval. Requests will be answered by email within 5 business days. A Certificate of Insurance is required for all facility use. Refer to Venue Rental Rates sheet for all costs associated with rental.

Organization *

or Company Name

Name *

List your first and last name

Email *

Phone *

Billing Address *

(Include City/State/Zip)

Event Name *

or Purpose of Facility Use

Date *

List all dates being requested for the facility use.

Time *

List the access and exit time requested for the facility use. If request is approved, these listed times will be when your group will be allowed access to the facility.

Attendees *

Estimated Number of Attendees

Point of Contact

During the event who will be the point of contact?

Email/Phone

List an email and/or phone number for the Point of Contact that will be on site during the event.

Building 1 Use

Check all areas that you are requesting to use for your event in Building 1.

Classroom 105 (Capacity 40)

Classroom 106 (Capacity 40)

Classroom 116 (Capacity 30)

Classroom 117 (Capacity 25)

Conference Room (Capacity 10)

Indoor Demonstration Arena

Kitchen

Lobby / Vendor Display Area (Showroom)

Other:

Building 1 Map

Computer Access

If your group will need access to the computers in building 1 classrooms for your event, list the name and email address of the person who will be on site to log into the computer. Log on instructions will be emailed to this person the morning of the event.

Grounds Use

Check all areas that you are requesting to use for your event.

Burn Building or Live Fire Props (for live fire use)

Burn Building Non‐Fire Use

Confined Space Rescue Maze

Driving Course

Mobile Home

Rail Tank Car, Haz‐Mat Tank Farm, Car Fire Prop, LPG Props

Technical Rescue Building

Ventilation Roof Prop

Water Rescue / Drafting Pond

Other:

Other Use Options

Check all areas that you are requesting to use for your event.

Entire Outdoor Campus & Props

Complete Facility Inside & Outside

Certified Trainer‐Instructor

Additional Information

If you have additional information that you would like to include about your request please enter it below.

Submit

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