Space Request

SPACE REQUEST

Name of Event

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Purpose of Event



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Event Date

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Start Time

: am    pm

Ending Time

: am    pm

Number of People Expected

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Contact Full Name

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Day Phone

____________________________________________________

Evening Phone

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Email Address

____________________________________________________

Group Name

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Group Leader

____________________________________________________

Additional Comments:



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Bring in or Mail to:
THE GALILEAN HOUSE OF WORSHIP
5078 A.L. Philpott Hwy.
Martinsville, Virginia 24112
276-638-2066
Dr. Michael Penn, Pastor
Gail N. Hagwood, Administrative Assistant