Scheduling Request

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Option 1

Option 2

Option 3

Option 4

Option 5

Contact Name:__________________________________

Organization Name:______________________________

Address:_______________________________________

_______________________________________________

Telephone Number:_______________________________

Fax Number:_____________________________________

E-mail Address:__________________________________

Event/Topic of Meeting:__________________________

Date of Event:___________________________________

Room Assignment: 1 - 2 - 3 - 4

Number Attending:________________________________

Event Start/Finish Time:_________________________

Will food and beverages be served during the meeting/event?
No - Yes

Provided by: ______________________

Bar Service:
Sponsored Bar Cash Bar None Requested

Media Services:
Please check equipment requested.All equipment may not be available so please ask for verification.
Podium - Mic/Pa - Screen - Other____________________

Anticipated Charges:
Room Fee: ______________________
Setup/Clean-up: ________________
Security: ______________________
Collateral Deposit: ____________
Bartending Fee: ________________
Media: _________________________
Total: _________________________

Non-refundable Deposit:
50% of Room Fee: ______________________

Remaining Balance:
(To be paid 14 days prior to the event) ______________________

Make Check Payable To: CFM Medical Properties,LLC
***** Late payment could result in the cancellation of the reservation.

270 Copperfield Blvd, Suite 203 / Concord, NC 28025 / 704-721-7438