Please complete the form below
to request an event at PPC.
Questions about scheduling an event?
Contact DENISE SIMONS AT 937.427.0130 OR
EMAIL: DSIMONS@PATTERSONPARK.ORG.

Name

First Name

Last Name

Phone

(###)

###

####

Email

Will you be the primary contact for this event?

Yes

No

If you are not the primary contact for this event, please provide their name, email, and phone number:

Event Name

Event Start Date

MM

DD

YYYY

Event End Date

MM

DD

YYYY

Is this a one-time event or a recurring event?

One-time

Recurring

If this is a recurring event, please list the recurrence schedule (daily, weekly, etc.) and any exceptions:

Event Start Time

Hour

Minute

Second

Event End Time

Event participants must leave the building by 9pm.

Hour

Minute

Second

What time would you like to begin setting up for event?

Hour

Minute

Second

How many people are you estimating will attend the event?

Briefly describe which rooms you would like to use and the room set-up for this event. If the event is offsite, please note this below.