Application for Social Hall Rental

please Enter the Date you want to Rent the Facility

-- mm/dd/yy

Please Enter the time you would like to rent the Facility

-- hh:mm:ss am/pm

Please provide the following contact information:

First Name
Last Name
Middle Initial
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

How much or many people will be attending?

Will there be alcohol during this event

Yes No
Please print this form as a back up and mail to prior to pressing the submit button:

Dumfries-Triangle Rescue Squad

Attn: Social Hall Rental

P.O. Box 460 , 3800 Graham Park Road

Dumfries , VA   22026

Or you may fax it to:

(703) 221-1611