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UNITED LUTHERAN CHURCH Telephone: 342-5808 <br /> 2230 Washington Street ~ j ~ OfJ,fice Hours: a.m. - 1 p.m. <br /> Eugene, Oregon 97405-2699 ~ ~7 f=~fpf,~Sr` (P <br /> APPLICATION r / <br /> FOR _ <br /> USE OF CHURCH FACILITIES AND EQUIPMENT ~ 6~ <br /> Facilities san fellowship hall y ~o m it o m <br /> requested ki s~eern other <br /> Equipment org Steinway piano other piano <br /> requested other <br /> Custodial or set up/clean up keys (S10 dep.) other (specify) <br /> other services <br /> Date(s) of Hours of activity: <br /> activity Hours of occupancy: <br /> Description of QjG~~I I <br /> activity ~ <br /> Qf~~/1 ?V" ~ <br /> ig <br /> Sponsor of outs ate <br /> activity and Name To: le hon <br /> <br /> ""`statement of Address NO' ° <br /> purpose Purpose ~ s o--' <br /> (Organization's brochure ~ <br /> maybe attached) <br /> D ZZ <br /> Contact v~~~ <br /> person <br /> Address <br /> a~ <br /> Agreement 1~r I agree to assume responsibility for the observance of church regulations and <br /> ~~~>~.f the general conduct of the participants. I also assume liability for damages <br /> ~ V'~ Yhat might occur because of negligence, and I agree to indemnify and hold <br /> V~'' ' ~ harmless United Lutheran Church from any and aA claims, losses, or damages <br /> ~ arising out of use of the facility or equipment covered by this application. <br /> r <br /> ~ <br /> Signature:' <br /> ~ Date: 2 0 ~ n <br /> Approval for`~facility ~ Equipment <br /> Date(s) Personnel requir~ed~ <br /> ; <br /> CANCELLATION: The USER SHALL NOTIFY THE Approved-'~Y-=`~-T~,;Ii,G~~z.~~~ <br /> "HURCH of cancellation at least one (1) day in <br /> vance. The church reserved the right to C, <br /> cancel this permit at any time. Date <br /> C3-?3-07 AQF ~'~2 I PJ <br /> See Instructions and Regulations on reverse side FEB 1 4 2007 <br /> <br />