NUR SHRINE CENTER
Rental Request Form

Name: _________________________________________________________________

Address: _______________________________________________________________

Telephone Number: (        ) ________________________________________________

Date of Function: ________________________________________________________

Type of Function: ________________________________________________________

Number of People: _______________________________________________________

Starting Time: ___________________________________________________________

Ending Time: ____________________________________________________________

Special Needs:

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Call (302) 328-6100 (ext. 15) to discuss prices and available dates.