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 UsageInternal FacilitySport LeagueDoes Event Involve Firemen’s Home Members?*YesNoRoom Requested*Multipurpose RoomChapelDescription of Activity*Organization Name*Date of Event* Date Format: MM slash DD slash YYYY Start Time of Facility Use* : HH MM AM PM End Time of Facility Use* : HH MM AM PM Organization Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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 StyleTheater StyleConference StyleList Your Other Needs/Requirements*Description of What FASNY Buildings/Facilities/Grounds is being requested for use*FASNY Staff Required*YesNoFASNY Staff Services Dietary Department Maintenance Department Activities Department (services may be billed to user)Will there be sales of food, beverages, merchandise, etc.?*YesNoPlease describe sales*Does your organization have insurance?*YesNoSee insurance requirements for required certificate.Insurance Document*Accepted file types: pdf, doc, docx.Please download and complete the Applicant Service Agreement.Upload Completed Applicant Service Agreement*Accepted file types: pdf.