Gallery Rental Form Gallery Rental RequestName *First and LastCompany If applicablePhone *Include Area CodeEmail Reservation Date *Reservation Start Time *010203040506070809101112HH000510152025303540455055MMAMPMAM/PMReservation End Time *010203040506070809101112HH000510152025303540455055MMAMPMAM/PMHow many chairs do you need? If none, leave blankHow many 6ft tables do you need? If none, leave blank.Are you a member? Collegiate - 15% DiscountArtist - 15% DiscountIndividual - 15% DiscountFamily - 15% DiscountBronze - 20% DiscountSilver - 20% DiscountGold - 20% DiscountNot a member.Additional Amenities Needed This can be changed at any time and is included in the rental rate.Audio/MicFlat ScreenPodiumKitchenetteBy submitting this request you agree to the following upon payment I will adhere to the start and end time of my rental. I understand that I have a one (1) hour set up and break down time before and after my rental start and end time. I will leave the facility in the condition that I received it. I will assume responsibility for lost keys and will pay the $15 replacement fee. I understand that the restrooms are to be locked at the completion of my rental. By submitting this form, I am agreeing to and accepting responsibility for the aforementioned. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank: