Date of Request: ___________________________
Date of Program: _______________________
Time of Program: _______________________

What type of service do you wish to book? Check one:
___ ON-SITE PROGRAM at St. Mary's Spiritual Center
___ OFF-CAMPUS PROGRAM provided by SMSC at some other location
___ USE OF FACILITIES when you provide your own program and leader at SMSC

Organization: ______________________________________________________

Street Address: ____________________________________________________

City, State, Zip: _____________________________________________________

Contact Person: ________________________________
Position: _________________________________
Phone: ___________________________________

Title of Program: ______________________________________________
Participating Group: ________________________________________
Estimated number of people: _______
Location: ____St. Mary's Spiritual Center
____ Off campus site address: _____________________________
Program leader: ____
(Check here if program leader is to be designated by St. Mary's Spiritual Center)

~~~~~~~~~~~~~~~~~~~~ For office use only ~~~~~~~~~~~~~~~~~~~~

Fee: $_____________
Type of service to be provided by the Center:
Part-day Program: ____ Use of Center's physical facilities only:
One-day Program: ____ Old Seminary Chapel: ____
Other: ______________________ Center: ____
____________________________ Spiritual Center Grounds: ____