Rent a Room Form

Contact Name(Required)

First Last

Phone(Required)

Email(Required)

Business Name(Required)

Business Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Federal Tax ID # (Not Sales Tax Exempt #)(Required)

Have you rented space at MPTC before?(Required)

Yes

Is your organization a Non-Profit 501c?(Required)

Yes

Campus Location(Required)

Fond du Lac

Beaver Dam

West Bend

Event/Meeting Title Name(Required)

Event/Meeting Date(Required)

Reservation Start Time / Reservation End Time(Required)

Number of Attendees(Required)

All classrooms are equipped with a computer/projector/doc cam. If you have any additional technologies needs please note them here.

Additional requests or questions, please note them here.

Consent

I understand that an MPTC Representative will be in contact with me about this request and I can follow-up by calling 920-924-3223 if needed.

I agree.

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