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 _______________________