Room Rentals

Applicant Name *

Applicant’s name MUST be on the insurance documents, be first on-site and stay on the premises for the duration of the event.

First Name

Last Name

Organization Name (if applicable)

First Name

Last Name

Organization Phone (if applicable)

(###)

###

####

Is your organization a non-profit entity? *

Yes

No

Primary Phone *

(###)

###

####

Secondary Phone

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred method of contact: *

Email

Phone

Either

Are you a current Yu-Ai Kai Senior Member? *

Yes

No

Requested Facility: *

Yu-Ai Kai (YAK)

Akiyama Wellness Center (AWC)

Requested Room(s): *

YAK: Room 100

YAK: Room 200

YAK: Room 202

YAK: Room 300

YAK: Room 301

AWC: Sakura

AWC: Kaki

AWC: Ginkgo

AWC: Maple

AWC: Pine

AWC: Kitchen

AWC: Back Lot

Requested Event Date: *

MM

DD

YYYY

Requested Event Date (Second Choice): *

MM

DD

YYYY

Set-up Time *

Hour

Minute

Second

AM PM

Event Start Time *

Hour

Minute

Second

AM PM

Clean-up Time: *

Hour

Minute

Second

AM PM

Exit Time (Not to exceed 10:00 pm): *

Hour

Minute

Second

AM PM

Is this event private or public? *

Private

Public

Will a fee be charged? *

Yes

No

Will refreshments be served? *

Yes

No

Will you be using a 3rd party? *

Yes

No