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Home
Healthy Today
Philanthropy
Why Give
Giving Opportunities
Grateful Patient Program
FAQ’s About Giving
Mosaic Life Stories, Cancer Care
CARES Act
Philanthropy Team
Mosaic Life Care Auxiliary
Auxiliary Board of Directors
Auxiliary Funding
Auxiliary Gift Shop
Auxiliary Membership
Volunteer Services
Volunteer Opportunities
Become a Volunteer
Healthy Tomorrow
character education emPowers
emPowerU
e2 Fellowship
Programming Annual Report
STEAM After-School
STEAM Camps
Camp Invention
Healthy Together
character education emPowers
Think Ahead Works®
Scholarships
Grants
Albany
Gift Shop
Hospital Philanthropy
FAQ’s About Giving
Ways To Give
Why Give
Volunteer Services
Become a Volunteer
Volunteer Opportunities
Ways To Give
Donate Now
Mosaic Life Care Foundation
Facility Rental Request
Please complete and submit the form below. All requests are reviewed, and you will be notified of approval or denial within 1 - 2 business days.
RENTER INFORMATION
Organization or Group Name
(Required)
Type of organization
(Required)
For-profit
Non-profit
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Contact Name
(Required)
First
Last
Contact Email
(Required)
Contact Phone
(Required)
Emergency After Hours Contact
Contact Email
(Required)
Contact Phone
(Required)
RESERVATION INFORMATION
Event Name
(Required)
Type of Event
(Required)
Education Training
Special Event
Team Retreat
Vendor Fair
Other
Date(s)
(Required)
Setup time
Hours
:
Minutes
AM
PM
AM/PM
Breakdown time
Hours
:
Minutes
AM
PM
AM/PM
Event start time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Event end time (include breakdown)
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Space request (check all that apply)
(Required)
emPower Central
Imagine Cafe
Innovation Room
Blue Collaboratory
Green Collaboratory
Purple Collaboratory
Red Collaboratory
Yellow Collaboratory
Anticipated Attendance
(Required)
Room Configuration
(Required)
Classroom
Pods
U-Shape
N/A
Other
Technology/service needs
(Required)
Projection
Microphones
White board
WiFi
Zoom (Innovation Room Only)
Food/beverage
(Required)
Snacks and drinks
Catering service
No food or drink
Additional comments
CAPTCHA
