Pasadena Buddhist Temple

1993 Glen Avenue, Pasadena, CA 91103 • Phone: 626-798-4781 • FAX: 626-345-9095

Resident Minister: Reverend Gregory Gibbs

http://www.PasadenaBuddhistTemple.org

revised-01/07/2020

FACILITY USE APPLICATION

Date and Day of Event:	- M - T - W -Th - F - Sa - Su
Name of Organization/Applicant:	Date of application:
Contact (Responsible) person:	- PBT Member - Non-member
Email address:
Best Phone #: xxx-xxx-xxxx	- mobile - home - business
Complete Mailing Address (include city/zip)

Hours Requested	Area(s) Requested
Actual time of event:	-Classroom A (north)	-Gym (Sakai Hall)
Time including set-up/clean-up	-Classroom B (south)	-Gym (Sakai Hall)+ kitchen
Estimated Attendance	-Classroom + kitchen	-Hondo
-Parking Lot	- Entire premises

Please describe the type of event and program:

Equipment/Furniture requested (tables, chairs, sound system etc):

Special Set-up? Please describe:

Pasadena Temple Member Reference (name) if applicant not a member:

Signer agrees to donate for use of facility, provide cleaning deposit and clean the facilities per Facilities Use form. Completion of this application does not constitute a confirmed facility reservation. Only after the PBT Board has reviewed and approved the facility request will this rental request be considered a confirmed reservation.

Signature ________________________________________________