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Dragonfly Room Request Form
Please fill out this Form to request the use of our Dragonfly Room in the Healing Arts Center of the Eastern Shore. If you have any questions, please contact us at
eshealingartscenter.com
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Email
*
Your email
What is your Name?
Your answer
Address?
Your answer
Email?
Your answer
Phone Number?
Your answer
What are the Dates & Times you are interested in?
Your answer
How many people are you expecting?
Your answer
What Items will you need?
Tables
Chairs
Projector
Will you need assistance setting up your event?
Yes
No
Maybe
Clear selection
Are you currently a tenant at the Healing Arts Center?
Yes
No
Clear selection
Will this be a Paid Event?
Yes
No
Donation Based
Clear selection
Would you like Alexis to Contact you about Promoting your Event?
Yes
No
Clear selection
What is the best way to contact you?
Email
Phone
Text Message
Send me a copy of my responses.
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