2. Town of Shoshoni Community Room
   104 East 2nd Street
   Shoshoni, WY 82649
   Phone: 307-876-2515
4. Today's Date*
   Today's Date
5. Responsible Party*
7. Company Name
9. Address*
11. City*
12. State*
13. Zip*
15. Email
17. Phone Number*
19. Type of Event*
21. Date & Hours of Event*
    Date & Hours of Event Start Date

    Date & Hours of Event Start Time

    —

    Date & Hours of Event End Date

    Date & Hours of Event End Time
23. Will You Be Using the Kitchen?*

    1. Yes

    1. No
25. If using the stove top/oven, you must use the fan. If the fire suppression system is activated due to not using the fan, you will be held responsible for all bills and fees associated with resinstallation.
26. Agreement*

    1. I understand and agree
28. Pre-Inspection
    A pre-inspection of the facility will be completed when the building key is picked up.
30. Damages will be assessed and billed to the responsible party.
    Inspection and return of key will be done within 24 hours after the event unless authorized by Town Clerk.
31. Agreement*

    1. I understand I can be billed for damages
33. There is a mandatory $100 cleaning deposit for use of this facility.
34. Agrement*

    1. I understand and agree
36. Type of Deposit

    1. Check

    1. Cash
37. Please drop off or mail deposit to Shoshoni Town Hall, PO Box 267, Shoshoni, WY 92649
39. Electronic Signature *
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit Submit and Print

* indicates a required field