2. First Name*
3. Last Name*
5. Date of Birth*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Fax Number
16. Email Address*
18. Date & Hours of Use*
    Date & Hours of Use Start Date

    Date & Hours of Use Start Time

    —

    Date & Hours of Use End Date

    Date & Hours of Use End Time
19. Facility Requested*

    1. Full Banquet Room (up to 160 guests)
    2. Half Banquet Room (up to 80 guests)
    3. Gymnasium
    4. Conference Room
20. Room Rates

    Full Banquet Room - $350 for 1-4 hours

    Half Banquet Room - $200 for 1-4 hours

    Gymnasium - varying rates, please call 252-939-1330

    Conference Room - $50 for 1-4 hours

    $25 each additional hour over 4 hours

    $25 each hour after normal business hours

21. Head Count*
23. Description of Activity/Event*
25. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
27. Electronic Signature*
29. Please Note
    Reservation requests must be made a minimum of 7 days prior to the event. Rentals are first come, first serve with full payment required at time of booking. Completing the Event Rental Application does not guarantee reservation for the date and time requested. Within 24 hours (Monday - Friday), our team will contact you after receiving the Event Rental Application to confirm availability on the date and time requested.
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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