Rental Exchange Program Request Form

Before filling out this form, please be sure you have:
1. Reviewed the Rental Rates and Policies
2. Browsed the Rental Calendar

Please note that the CounterPULSE office hours are Tues.-Fri. 12pm-6pm

Please use the comments field to provide details.

First Name
Last Name
Street Address
City
State/Province Zip Code
Country
Phone
Your E-Mail Address
What type of event will you be doing? (Please check one).	Class/Workshop Gallery Performance/Event Photo/Video Shoot Rehearsal/Meeting Other (explain)
Please describe exactly what you will be doing at CounterPULSE: What dates and times are you hoping for? Date of event Start time of event End time of event Please describe the technical requirements and also and other special requirements that we should know about, e.g. will you need to use the kitchen or is your event sensitive in natureand requiring complete privacy? Please be specific. Technical Requirements How did you originally learn about CounterPULSE?
Do you understand CounterPULSE's rental policies? Yes, I read and understood the rental policies.

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1310 Mission St. (near 9th), SF, CA 94103 415-626-2060 info@counterPULSE.org

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