YWCA

at the University of California, Berkeley

2600 Bancroft Way (at Bowditch) - Berkeley, CA 94704 - (510) 848-6370 - Fax: (510) 848-6375 

APPLICATION FOR USE OF FACILITIES 

Organization: __________________________________________________________________ 

Contact Person: ________________________________________________________________ 

Address of Organization: _________________________________________________________  

Phone: ______________________________ Purpose of Event: __________________________ 

FAX: _______________________________ 

Room(s) Requested: ____________________________ Rental Rate: ___________/hour

Date: ____________________________  Hours From: __________ To: __________

Date: ____________________________  Hours From: __________ To: __________

Date: ____________________________  Hours From: __________ To: __________

Date: ____________________________  Hours From: __________ To: __________

_____________________ Hours x ____________/hour =   ______________________ 

Refundable cleaning/damage deposit:    ______________________ 

Setup/takedown charge:      ______________________ 

Other charge:        ______________________ 

TOTAL AMOUNT DUE BY ______________________ AT 3:OOPM: _____________ 

I HAVE READ THE REGULATIONS PERTAINING TO ROOM RENTALS AT THE YWCA AND AGREE TO ABIDE BY THEM. I WILL BE RESPONSIBLE FOR ANY INFRACTIONS. 

______________________________________________________________________________

SIGNATURE         DATE 

Position in Organization: _________________________________________________________ 

Home address: _________________________________________________________________ 

Home phone number: ____________________________________________________________ 

In case of an emergency, contact the caretaker: 843-2342 

GENERAL REGULATIONS 

Renters using the YWCA assume all responsibility for loss and/or

damage to both property and person while meeting in this building. 

Reservation of Space 

Types of Events and Related Publicity

General

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