ST. LUKE’S CHURCH
ROUTE
9
CLERMONT,
NEW YORK
APPLICATION
FOR USE OF ST. LUKE’S CHURCH
DATE OF REQUEST
___________________
NAME
________________________________________________________________
ADDRESS
____________________________________________________________
_______________________________________________________________________
PHONE
NUMBER ____________________________________________________
DATE
OF USE OF CHURCH __________________________________________
TIME
_________________________________________________________________
PURPOSE
OF USE/EVENT ___________________________________________
APPROX.
NUMBER ATTENDING ____________________________________
I
AGREE TO THE TERMS, AS SET FORTH, FOR THE USE OF
ST.
LUKE’S CHURCH.
SIGNED
______________________________________________________________
FOR
OFFICE
USE:
RECEIVED
________________________ PAYMENT
__________________
APPROVED/DENIED
______________
SIGNATURE
_______________________