Intermedia Arts | Rental Request Form

//Intermedia Arts is a catalyst that builds understanding among people through art.//

Group Information
Group/organization name (if applicable):
Primary contact name: *
Street address: *
City: *
State: *
Zip: *
Address location (home, business):	Home Business
Business phone: *
Cell phone: *
Email: *
May we add you to our mailing list?	Yes No Already on mailing list
Registered non-profit/501c3 status?	Yes No
If not, do you have a 501c3 fiscal agent?	Yes No Not Applicable
Fiscal agent name:
Event Information
Event date(s): *
Event name:
Event description:
Event start time:
Schedule and description of activities (arrival, set-up, event, clean-up, etc): *
Event location(s) (theater, Agustín Gallery, Main Gallery):
Expected audience count:
Number of Intermedia Arts technicians and times needed (min. of one technician required if using tech equipment):
Tech rehearsal dates/times (if applicable):
Equipment needs (sound, lighting, projection): [ see equipment list ]
Load-in or prep hours needed:
Rehearsal hours needed:
Are you interested in having your event listed on our marquee for a fee? (Available only for 2+ week rentals)	Yes No
Additional questions/comments:
	asterisk (*) denotes required field

Space Rental Request Form