Facility Use Application

Organization/Individual Name:

Representative: Tract/Lot:

Address: Phone:

Service organization/individual provides to PMCPOA members: ______

Number of PMCPOA members in organization:

Percentage of PMCPOA residents/members in total membership of organization:

Organization membership fees/dues:

Date(s) of gathering(s):

Time: Room Requested:

Please read and sign: Pursuant to the regulations of the Kern County Health Department, only food catered by the Bistro on the Greens or other licensed, bonded and insured caterers may be brought into the main building of the PMCPOA Clubhouse. Food may be brought into the Condor Room or Pool Pavilion ONLY. Food brought into the Condor Room or Pool Pavilion may only be stored in the kitchen in the room reserved for event. Prior approval of the use of alcoholic beverages must be obtained through the Chief Operation Officer.

I have read and understand the above requirements, and do agree to maintain compliance: Yes/No

Please Print Name Signature of Requestor

Office Use Only

Approved PMC Organization Non-Sanctioned PMC Organization

Approved by the PMCPOA Chief Operating Officer Date:

_________________________________________

Chief Operating Officer

Revised:12-2-05