Pasadena Buddhist Temple

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

Resident Minister: Reverend Gregory Gibbs • Assisting Minister: Reverend Tetsuo Unno

http://www.PasadenaBuddhistTemple.org

FACILITY USE APPLICATION

Name or Organization:	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)
Date and Day of Event:	[ ]-M [ ]- T [ ]-W [ ]-Th [ ]-F [ ]-Sa [ ]-Su

Area(s) Requested [ ] – Classroom A	[ ] Gym	[ ] – Classroom B	[ ] Gym + Kitchen	[ ] – Classroom + Kitchen [ ] – Entire Premises [ ] – Other __________________________________

Hours Requested:	-
Set-up Time:	-
Hours of Event:	-
Estimated Attendance:

Please describe the type of event and program:

Equipment/Furniture requested (tables, chairs etc):

Special Set-up? Please describe:

Pasadena Temple Member Reference (name):

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 ________________________________________________