You are welcome to use the form below to e-mail Augustana your request to use its facilities. Someone from Augustana's staff will contact you regarding availability and fees.

Building Use Application
Name of Organization*
Name of Contact Person*
Phone of Contact Person*
	Work   Cell   Home
E-mail of Contact Person*
Address of Organization*	Street Address Address Line 2 City State / Province / Region Postal / Zip Code Antigua and BarbudaAruba,BahamasBarbadosBelizeCanadaCook IslandsCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNetherlands AntillesNicaraguaPanama Puerto Rico Saint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColombiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFaroe IslandsFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorHong KongIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPalestinePhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosDemocratic Republic of the CongoRepublic of the CongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGibraltarGuineaGuinea-BissauCote d'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandUnited Republic of TanzaniaTogoTunisiaUgandaZambiaZimbabwe Country
Is your organization a non-profit organization?*	Yes   No
Please give a brief description or mission statement about your organization.
This application pertains to:*	one-time facilities use   recurring facilities use
Type of Event (check all that apply)	Music Rehearsal   Class   Concert Performance   Meal   Reception   Meeting   Fund-raiser   Worship   Volunteer Work
Other (please explain)
Date of Event*	MM / DD / YYYY
Set-up Time*
Event Start Time*
Event End Time*
Vacate Room Time*
Date of Second Event	MM / DD / YYYY
Set-up Time
Event Start Time
Event End Time
Vacate Room Time
Date of Third Event	MM / DD / YYYY
Set-up Time
Event Start Time
Event End Time
Vacate Room Time
Add additional dates, set-up times, event start times, event end times, and vacate room times here:
Estimated number of people attending
Room(s) Requested (check all that apply)	Fellowship Hall/Kitchen   Anna Paulson Room/Kitchen   Sanctuary   Christ Chapel   Classroom   Ammerman Library   Music Room   Youth Room   Courtyard   Memorial Garden   Nursery
Other (please explain)
Media Requested (check all that apply)	Podium   Microphone   Dry Erase Board   TV/VCR/DVD   Easel(s)   Projection Screen   Coffee Maker   Piano
Set-up Requested (describe placement of tables, chairs, serving tables, podium, media, etc.)
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