Collaboration Space Reservation Request

Company/Organization*

Type of Organization*

Your Name*

First NameLast Name

Phone Number*

to contact you regarding this request

E-mail*

example@example.com

Number of Guests*

Date of intended use of space*

Date

Time of intended use of space*

Hour Minutes

AM/PM Option

Until

until

Hour Minutes

AM/PM Option

Total 0.0

Which space(s) are you interested in reserving?*

Conference Center (maximum capacity: 30 guests)Collab 1 (maximum capacity: 6 guests)Collab 2 (maximum capacity: 14 guests)Collab 3 (maximum capacity: 12 guests)

Number of Days you will be using the space*

Please provide a brief description of the intended use of the space:*

In lieu of a rental fee for room(s) use, we ask that businesses make a donation to a local non-profit based on the suggested donation schedule below. An acknowledgment of the donation should be provided to the Harvest Foundation within seven (7) days after the room has been used. A sample acknowledgment letter will be provided to you upon completion of this form:

Suggested Donation Schedule

Conference Center		$250
Collab 1		$50
Collab 2		$100
Collab 3		$100

Based on your reservation request, your suggested donation amount is ${calculation}.

The non-profit you choose must operate within Martinsville or Henry County.

Calculation

PLEASE NOTE: We are not a fully staffed conference center and therefore you will be responsible for maintaining your meeting space.

If your request is approved, A Reservation and Use Agreement will be sent for signature upon that approval and two signatures will be required:

Signature 1: "responsible party" this person is to be present at the meeting and will be responsible for making sure that the room is properly maintained.

Signature 2: "authorized representative" this person is the individual authorized by {companyorganization} to represent {companyorganization} (typically your CEO/President).

Please provide the required information for these two individuals below:

"Responsible Party" Name*

First NameLast Name

"Responsible Party" Email*

example@example.com

"Authorized Representative" Name*

First NameLast Name

"Authorized Representative" Email*

example@example.com

Please review your entries before hitting Submit.

Space Reservation Request Form