Form Center

2. The Franklin Center of Advanced Learning & Enterprise
   50 Claiborne Avenue
   Rocky Mount, VA 24151
   Phone: 540-483-0179 Fax: 540-483-1297
   E-Mail: InfoAtTheFranklinCenter@franklincountyva.gov
   Internet: http://www.thefranklincenter.org
4. Company Name
5. Contact Name
6. Address
8. City
9. State
10. Zip
12. Work Phone
13. Cell Phone
14. E-Mail Address
16. Name of the Meeting or Event
17. Facilities Reserved
18. Facilities Reserved
20. Date Facilities Reserved for
    Date Facilities Reserved for
21. Activity Time Begin
    Activity Time Begin
22. Activity Time End
    Activity Time End
24. Description of Event & Notes
26. Rental Fees

    1. Non-Profit Business Half Day (up to 4 hours) $35.00
    2. Non-Profit Business Full Day $100.00
    3. For Profit Business (up to 4 hours) $100.00
    4. For Profit Business Full Day $200.00
    5. Weekend Rate for ALL Groups $350.00 plus hourly custodial rate
28. Weekend Rate for ALL Groups $350.00 plus hourly custodial rate
30. # of Rooms to Be Reserved
31. Total Due
33. If you are a non-profit, you MUST attach a copy of your IRS tax exempt form to receive non-profit rates.
34. Approximate Number of People Attending
36. Catering Table Needed? Local Catering Contacts are available upon request. Snack & Soda vending machines available on site. Please note: Furniture may not be moved and the person who signs this form is responsible for enforcing the rules.

    1. Yes
    2. No
38. If your organization needs a video conference room, please provide the following information. If you need video conferencing, our staff will contact you via phone or e-mail to set up a time for you to come in and test audio/visual technology and correct performance for your event.
    IP Address for Video Conference (if needed)
40. By typing your name, you are certifying that you have read and agree with the following statement in its entirety and that the information provided on this form is true and accurate.

    I agree that my typed name on this application is the legally-binding equivalent to my hand-written signature. I will not, at any time in the future, repudiate the meaning of this signature or claim that this signature is invalid and/or not legally binding.

    1. I agree.
42. Electronic Signature
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field