APPLICATION FOR BUILDING USE
Please complete the form and return to: Cong. Beth Elohim, P.O. Box 2218, Acton, MA 01720 or fax to: 978-263-8610
at least four (4) weeks prior to date of event
1. Date of Application ___________________________
2. Name of Applicant (organization or individual) _________________________________________________________
Address_______________________________________________________________________________________
Phone (day)_______________________________ Phone (evening) ______________________________________
3. Event Date _______________________ Time: From _______________ To _______________
Set-up Date _______________________ Time: From _______________ To _______________
Clean-up Date _____________________ Time: From _______________ To _______________
4. Facilities Needed: [ ] Social Hall [ ] Sanctuary [ ] Community Court
[ ] Kitchen [ ] Classroom(s)
Other: ________________________________________________________________________________________
5. Type of Activity _________________________________________________________________________________
_____________________________________________________________________________________________
6. Approximate Number of People: _____Adults _____Children
7. Equipment Required: Chairs (CBE has 90) _______
Round Tables: 72" (CBE has 12) ________ 60" (CBE has 10) ________
Rectangular Tables: 8’ tables (CBE has 9)_______ 6’ tables (CBE has 3) _______
Other: ________________________________________________________________________________________
8. Name of Caterer: ______________________________________ Phone number: ___________________________
Contact name: ________________________________________
9. Alcohol being served? (requires liability insurance certificate) _______________
[Y/N]
10. Name of Florist _________________________________________ Phone number: __________________________
11. Equipment Rental (chairs, tables, linens, etc) _________________________________________________________
Phone number: ______________________________ Delivery date/time: _________________________________
(over)
I have read the "Building Use Policy" of Congregation Beth Elohim. I agree to abide by the rules and regulations related to the use of this facility in their entirety. I and/or my organization will hold the Board of Directors and Congregation Beth Elohim and all its agents and representatives harmless from any problems resulting from leasing or utilization of the premises.
_______________________________________________________________ _________________________
Signature Date
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TO BE COMPLETED BY BETH ELOHIM STAFF ONLY
Application Received: _____________________________________________ _________________________
Congregation Secretary Date
Event Coordinator: _________________________________________________________________________________
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Approvals Required (Indicated by X)
[ ] _____________________________________________________ _________________________
Congregation Secretary (date & space available) Date
[ ] _____________________________________________________ _________________________
Board Representative (non-Congregant applications) Date
[ ] _____________________________________________________ _________________________
Rabbi (Caterer approval) Date
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Applicant Notified: _______________________________________________ _________________________
Congregation Secretary Date
Comments/Instructions _____________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________
Estimated Fees (schedule attached) ____________________
Fees Collected ____________________ ____________________
Amount Date
____________________________________________________
Received By
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P.O.Box 2218 133 Prospect Street Acton, Massachusetts 01720 Phone 978-263-3061
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Cost of Building Use
EVENT
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SPACE
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SETUP
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MEMBER
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NONMEM
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Regular Kiddush following Bar/Bat Mitzvah (<1 hour)
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Kitchen, Social Hall and/or Community Court
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2-3 tables for food & beverage
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N/C
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N/C
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Extended Kiddush following B/BM (1-2 hours)
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Kitchen, Social Hall and/or Community Court
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tables for food & beverage, tables and chairs for seating as desired, etc. (setup and cleanup)
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$200
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$400
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Luncheon (4-5 hours)
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Kitchen, Social Hall, etc. (CBE MEMBERS ONLY—partial use of Sanctuary space)
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Tables, chairs, etc. (setup and cleanup)
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$400
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$800
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Dinner, wedding (evening event of 4-5 hours)
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Kitchen, Social Hall, etc. (CBE MEMBERS ONLY—partial use of Sanctuary space)
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Tables, chairs, etc. (setup and cleanup)
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$750
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$1500
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Wedding Only (non-member)
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Sanctuary
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$500
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Use of upstairs space for non-profit groups (Hadassah, JCC, etc.)
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$30/hr.custodial time
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