Date of Event ____________________ Time of Event ________________
Purpose of Event ______________________________________________
Name of Applicant _____________________________________________
Mailing Address _______________________________________________
Phone _____________________
Email ______________________________________________________
Name and Address of Organization (if applicable) _______________________
___________________________________________________________
Nonprofit ___ yes ___no
The undersigned applicant agrees to accept the Use Restrictions as stated in the DHCC Rental Information.
Please complete, sign, and return this agreement along with a check for the appropriate fee to:
Clay Parsons
Deer Harbor Community Club
PO Box 187
Deer Harbor, WA 98243
Email questions to Clay Parsons at clay@alternativefutures.com
Signature of applicant ___________________________________
Date _______________
Amount enclosed $_______________
__________________________________________________________
F O R O F F I C E U S E O N L Y :
Before Event
Amount Received: Rental Payment $__________ Security Deposit $__________
After Event
Facility Check __________ Security Deposit Refund $__________
