a learning place

A Learning Place Training Center
Request to use facility

Complete this form to either reserve space or seek general information about renting the facility. Information will be e-mailed to you.

Name:

Date of request:

Address:

City/State/Zip:

Phone:

E-mail:

Activity description:

Date(s) required:

Total time required:

Actual start time: Actual end time:

Number attending:

Is this a non-profit or school event?

Facility space requested:

Setup requirements:

Audio visual requirements:

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PO Box 616 201 RM Davis Parkway Suite A Piqua, Ohio 45356