Event Participation Request Form

Organization Info

Contact Person:

First Name

MI

Last Name

Email

Contact Phone Number:

Organization Name:

Organization Website:

Organization Tax ID #

Mailing Address

City

State

Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau

Zip Code

Details of Request

Type of Request

Please select... Wayne Metro Participation in Event Requesting Use of Wayne Metro Facilities

What is the cost to participate?  If free, please put 0.

Event/Project Name:

Event/Project Date(s) 

Time Frame of Event/Project

Event/Project Address:

City:

Zip Code:

Overview

Projected attendance/participation: (if not applicable, use n/a)

Who will be served by this event and how does it help empower low-income individuals and/or strengthen Wayne County communities?: 

Due date of materials/funds:

Please specify request details:

Other community organizations participating at the event:

Name of Event Sponsor(s):

Please upload any supporting materials or flyers: