Convening Room or Space Application Form Organization InformationCompany Name*Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Name* First Last Contact Title*Phone*Contact Email* Organization Sector*Animal-RelatedArts, Culture & HumanitiesCivic and Social"Civil Legal AidCivil Rights, Social Action & AdvocacyCommunity Improvement & Capacity BuildingCorporationCrime & Legal-RelatedDiseases, Disorders & Medical DisciplinesEconomic DevelopmentEducationEducational ServicesEmploymentEnvironmentFieldFood, Agriculture & NutritionFunder/FoundationHealth CareHousing & ShelterHuman ServicesInternational, Foreign Affairs & National SecurityMental Health & Crisis InterventionProfessional Societies & AssociationsPublic & Societal BenefitResearch InstitutionScience & TechnologyYouth DevelopmentIs organization a non-profit?*YesNoPlease describe your organization, mission and the constituents/customers that you serve*Event InformationEvent Title*Expected Attendance*Event Date* Date Format: MM slash DD slash YYYY Start Time* HH : MM AM PM End Time* HH : MM AM PM Entry/Setup Time* HH : MM AM PM Is the event open to the public?*YesNoIs registration required?*YesNoWould you like to use Co.act's registration template?*YesNoIs this a recurring event/meeting request?*YesNoIs there a cost to attend this event?*YesNoIf yes, indicate cost*Would you like Co.act to help promote your event?*YesNoIf yes, share promotional language, registration link, and when (date) you would like Co.act to start promoting your event*Please describe your event, goals, participants and why you are interested in Co.act Detroit*Space InformationRequested Room or Space*(Space images and details available by clicking here)The Gathering Space (Flexible Meeting Area)Capacity: 14-80 peopleThe Communal Table (Open Meeting Room)Capacity: 16-22 PeopleThe Pavillion (Large Conference Room)Capacity: 10 peoplePeanut Butter Block (Medium Conference Room)Capacity: 8 peopleBumpy Cake (Small Conference Room)Capacity: 6 peopleRoom Layout* TheaterCapacity: 80 peopleWorkspaceCapacity: 50 peoplePodsCapacity: 50 peopleBoardroomCapacity: 32 peopleClassroomCapacity: 28 peopleHorseshoe (Right Side)Capacity: 18 peopleHorseshoe (Left Side)Capacity: 14 peopleOtherDescription of Other Layout*Will you be using a mac or a pc for your presentation?*MacPCN/A– Not connecting to digital devicesAmenitiesDoes your event require evening or weekend use?*YesNoWill food and/or beverages be served?*YesNoRequested Amenities* Projector/Monitor Handheld Mics (1-2) (Event Space Only) Registration Table Easel(s) Other None Number of Easels*Description of Other Amenities*AgreementsPost-Event Survey* I will complete Co.act Detroit's post-event survey.Policies* I have read and agreed to the Co.act Detroit Event Policy.PhoneThis field is for validation purposes and should be left unchanged.