GCC Facility Use Request Click Here for Rental Info "*" indicates required fields Organization*Name* First Last Title*Email* Phone*Start Date* MM slash DD slash YYYY Start Time* Hours : Minutes AM PM AM/PM End Date* MM slash DD slash YYYY End Time* Hours : Minutes AM PM AM/PM Purpose*Select Room and Rate*Conference Room, $200 per hourGymnasium, $250 per hourEntire Building, $450 per hourConference Room, $450 per dayGymnasium, $650 per dayEntire Building, $900 per dayNumber of Hours or Days*Cleaning Deposit Fee* $200 Cleaning Deposit Fee The cleaning deposit will be refunded in full once all items on the cleaning checklist have been verified.Total Credit Card Cardholder Name Card Details Billing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Signature*I, as a representative for the organization so named, agree to abide by the Copper River Basin Regional Housing Authority’s Facility Policies and to provide adequate supervision of those in attendance.Untitled First Choice Second Choice Third Choice CommentsThis field is for validation purposes and should be left unchanged.
