Jacumin-Simpson Reservation Form

Name of Church/Organization

Contact Name

First

Last

Phone #

Event Description

Anticipated Headcount

Please indicate the quantity of each item that you will need for your event. If you do not need a particular resource, please leave it blank.

Round Tables

Please enter a number from 0 to 12.

Chairs

Please enter a number from 0 to 84.

Rectangle Tables

Please enter a number from 0 to 4.

Cooler w/ Ice

Please enter a number from 0 to 2.