Community Meeting Space Request

Date of Request:

Organization Name

Address

City:

State:

Zip Code:

Contact Name:

Email:

Phone:

BCN team member meeting facilitator:

BCN team member on-site event host:

Event Date:

Day of Week:

Meeting Type

Recurring

One Time

Is a specific space at HQ being requested?

Number of anticipated attendees:

Setup Configuration:

Classroom Style

Theater Style

U-Shaped Table

A/V needs:

Any special needs:

Will food be served:

Yes

Will you have time for a BCN representative to give a brief presentation on our services?

Yes

Additional comments:

Please note the following:

Please provide an alphabetized list of your anticipated guests prior to the meeting date to expedite the check-in process.
While BCN does not charge for room utilization, donations to support our mission are appreciated.
Please do NOT tag Bluegrass Care Navigators in Social Media posts, utilize our logo or recognize our organization as a sponsor of your event without written approval to do so. Bluegrass Care Navigators will NOT publicize events held at our facility unless it is an event officially sponsored or co-sponsored by our organization.