Facility Request (Requests must be submitted 60 days prior to use date) FASNY strictly prohibits smoking on all FASNY property inclusive of ALL indoor and outdoor areas.Type of Request* General Usage Internal Facility Sport League Does Event Involve Firemen’s Home Members?* Yes No Room Requested* Multipurpose Room Chapel Description of Activity*Organization Name* Date of Event* MM slash DD slash YYYY Start Time of Facility Use* : Hours Minutes AM PM AM/PM End Time of Facility Use* : Hours Minutes AM PM AM/PM Organization Address* Street Address Address Line 2 City State 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 ZIP Code Contact Name* First Last Home PhoneWork PhoneCell PhoneEmail* Event Name/Description* Select All Event Needs/Requirements Tables Chairs Configuration (Tables/Chairs) Podium Microphone Public Address "PA" System Other How Many Tables?* How Many Chairs?* Select Configuration* Round Style Theater Style Conference Style List Your Other Needs/Requirements*Description of What FASNY Buildings/Facilities/Grounds is being requested for use*FASNY Staff Required* Yes No FASNY Staff Services Dietary Department Maintenance Department Activities Department (services may be billed to user)Will there be sales of food, beverages, merchandise, etc.?* Yes No Please describe sales*Does your organization have insurance?* Yes No See insurance requirements for required certificate.Insurance Document*Accepted file types: pdf, doc, docx, Max. file size: 1 GB.Please download and complete the Applicant Service Agreement.CAPTCHAUpload Completed Applicant Service Agreement*Accepted file types: pdf, Max. file size: 1 GB.CommentsThis field is for validation purposes and should be left unchanged.