AdventHealth Fieldhouse & Conference Center

210 Cypress Gardens Blvd. Winter Haven, Florida 33880

(863) 268-6733

FIELDHOUSE & CONFERENCE CENTER
RENTAL REQUEST APPLICATION

Organization Name:

Contact Name:

Address:

City/State/Zip:

Email Address:

Phone:

Fax:

Sales Tax Exempt Number (please attach photo copy):

Photo of Exemption Cert. (if applicable):

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Nonprofit License Number (if applicable):

Photo of Nonprofit License (if applicable):

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Driver License

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Requested Date(s) of Use:

Requested Space(s) (Click Map Below):

Space 1 - Gym Block A

Space 2 - Gym Block B

Space 3 - Gym Block C

Space 4 - Meeting Room C - F

Space 5 - Meeting Room G

Space 6 - Meeting Room A

Space 7 - Meeting Room B

Space 8 - Board Room

Hours (4 hour minimum):

Estimated Number of Attendees:

Will alcohol be served at your event?

Yes

Purpose & Brief Description of Event (Please give as much information as possible):