EVENT REQUEST FORM

Fo r Co nfe re nce Ce nt e r, Fire ho us e & M ee t ing and Act ivit y Sp ace s

Please fill out form completely.

Application Date: 5/5/08

Company/Individual Name Robert Walker
Billing Address 1166 Haight St. Apt 7 San Francisco Ca 94117
(Number & Street) (City) (State) (Zip)
Organization Phone Fax
Contact PersonRobert Walker Contact Phone 415-378-4292
Web site Email littlewalk66@hotmail.com
Event TitleSan Francisco Power of Angels Seminer/ Ruach Healing Certification
(This will be posted on Fort Mason Center's (FMC) Daily Schedule seen by the public)
How did you come to find out about Fort Mason (Circle Choice):
Agenda Magazine FMC Past Attendee Northside Magazine Theknot.com
Bay Area Parent Magazine FMC Tenant Referral Search Engine Vendor Referral
Customer Referral FMC Visitor Referral SFCVB Meeting Planning Guide Yellow Pages
Event Planner/Caterer Marina Times SFCVB Salesperson Referral Other

Please provide us with a brief description of your organization and event: Certification in Ruach Healing Method

Is your event public or private? Public Private

If your event is public, would you like a free listing in the Fort Mason Center Monthly? (please check one) Yes No
(If yes, please fill out the Event Information Sheet provided.)

Is your organization a Nonprofit with 501(c) 3 status?

If so, please provide a 501(c)3 letter and Federal ID# (must provide 501(c)3 letter for Nonprofit rate)

Please choose the category that best describes your organization (Circle Choice):

GROUP Association Medical Children Corporation Education

Ethnic Individual Seniors Religious Gay & Lesbian
Performance Technology Government Health Care/Wellness Other

Do you intend to serve alcoholic beverages? Hard Liquor Beer/Wine/Champagne None

$25 charge to get alcohol permit

Do you intend to serve or sell food? Yes No

Is this a catered event? Yes No

Prepaid Parking Validations/Valet Parking Yes No # of vouchers:

(If yes, please contact your sales associate)

Interested in Internet connection? Yes No # of users:

Interested in signage (If yes, please contact your sales associate) Yes No
PLEASE LIST ALL SPECIFIC DATES YOU WISH TO BOOK. Holidays should be considered when listing
dates.
Dates(s) 6/19-6/22/08

Venue(s) 1st Choice c235 2nd Choice

Contracted Hours: Beginning 5-9 Ending 12-8
Event Hours: Beginning 5-9 Ending 12-8
Anticipated Attendance: 40

RESOURCES

I will require the following: Chairs 45 Tables 0

(Show quantities)

Fort Mason Center Staff Set-up/Breakdown of Room? Yes No

($50.00, Meeting &Activity Space Clients Only)
Cleanup Fee/Food & Beverage Fee (For MAS only; 30% of total room rental fee) $

EQUIPMENT RENTAL (PER DAY OR EVENING) Please indicate quantities needed below.
Slide Projector $25.00 per day/eve
Overhead Projector $25.00 per day/eve
LCD Projector $150.00 per day/eve
Easel with Pad $25.00 per day/eve
Coffee Urn 55 Cup (Coffee not included) $5.00 per day/eve (Show quantity)
Hot Water (Tea) Urn (Tea not included) $5.00 per day/eve (Show quantity)
Table Cloths (white) $8.00 each (Show quantity)
Table Cloths (color) $10.00 each (Show quantity)
Table Cloths (drape to floor) $15.00 each (Show quantity)
Sound System (Conference Center/Firehouse only) $100.00
Cocktail Tables $10.00 each
Lavaliere Microphone $75.00
TV/VCR/DVD $100.00
Dance Floor (15x15) $250.00
(Conference Center/Firehouse Only)

All events must be paid in full (check, credit card, or money order are accepted forms of payment) prior to day of event to
ensure that the meeting space will be unlocked for booking.

PLEASE PROVIDE CREDIT CARD INFORMATION:

**REQUIRED FOR FILE
AMEX/MC/VISA No:5287169202954018 Exp. Date:08/10

Print name on credit card:Robert Walker

Billing Address: 1166 Haight st. Apt. 7 San Francisco CA. 94117

I authorize use of this credit card for payment. Signature:

CLIENTS ARE RESPONSIBLE FOR THE FOLLOWING: There is no fee for set-up/breakdown in Conference
Center and Firehouse spaces; cleaning fees may be applicable. There is a $50.00 fee for our staff to set up and break down
chairs and tables for a Meeting and Activity Room rental. We book events back-to-back; therefore clients should plan to use
only contracted time. Please contract time at the beginning and end of your event for your own set up and break down. Large
meetings and classes usually require an hour or more at either end. Special events and performances may require longer set-
up and breakdown time. Please be aware that unscheduled overtime use of the Conference Center and the Firehouse will
be charged at the rate of $150 per hour. Meeting and Activity Space clients will be charged at the rate of $35.00 per hour
for unscheduled overtime use.
**Please note some spaces may not meet ADA requirements.
F O RT M A S O N F O U N D AT I O N
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