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2. 
3. Please complete this form and choose Submit or Submit and Print to send it to The Hemmens Cultural Center. You will be contacted during the business week with date availability information and estimated rental fees. If you have questions, please contact The Hemmens Administration Office at 847-697-3616. Thank you.
5. First Name*
6. Last Name*
8. Primary Phone*
9. Type*

   1. Home
   2. Work
   3. Cell
10. Secondary Phone
11. Type

    1. Home
    2. Work
    3. Cell
13. Email Address*
15. Street Address*
16. Apt, Suite or P.O.Box
18. City*
19. State*
20. Zip*
22. How would you prefer to be contacted?*

    1. Phone
    2. Email
24. Rental requests must be submitted at least 30 days prior to date requested. New renters may request dates up to one year in advance of event.
26. FIRST Choice of Dates. Please select date of event or START date of event.
28. Month*
    -- Select One --JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
29. Day*
    -- Select One --12345678910111213141516171819202122232425262728293031
30. Year*
    -- Select One --20222023
32. FIRST Choice of Dates. Please select END date of event IF more than one day.
34. Month
    -- Select One --JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
35. Day
    -- Select One --12345678910111213141516171819202122232425262728293031
36. Year
    -- Select One --20222023
40. SECOND Choice of Dates. Please select date or START date of event.
    Enter alternate dates if first choice is unavailable.
42. Month (alternate)
    -- Select One --JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
43. Day (alternate)
    -- Select One --12345678910111213141516171819202122232425262728293031
44. Year (alternate)
    -- Select One --20222023
46. SECOND Choice of Dates. Please select END date of event IF more than one day.
48. Month (alternate)
    -- Select One --JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
49. Day (alternate)
    -- Select One --12345678910111213141516171819202122232425262728293031
50. Year (alternate)
    -- Select One --20222023
52. Event Times
53. In Time
    Set up time
54. Out Time
    Tear down time
56. Space Requested*

    Choose all that apply.

    1. Stage
    2. Exhibition Hall
    3. Lobby
    4. Entire Building
57. Type of Event*

    1. Dance Recital
    2. Concert
    3. Musical Production
    4. Play
    5. Wedding
    6. Reception

    1. Party
    2. Quinceanera
    3. Exhibition
    4. Conference
    5. Other
59. If other type of event, enter type of event here
61. Will alcohol be served?

    (Bar services are contracted with Hemmens concessionaires only.)

    1. Yes
    2. No
    3. Unsure
62. Are you interested in using The Hemmens Box Office for ticketing?

    1. Yes
    2. No
    3. Unsure
64. Describe your event details.
66. Upload attachments such as event details, diagrams and production riders here.
68. If you wish to receive an email copy of this form instead of printing, please check the box below and enter your email address.
    An email copy of the form will be sent to the email address you provided when you click Submit.
Leave This Blank:


70. 1. Receive an email copy of this form.
71. Email address

    This field is not part of the form submission.

72. Submit Submit and Print

* indicates a required field