2. 

4. This form is to request a rental at Highland Springs Clubhouse, Rock Island, IL.

6. Rental reservations should be made in advance. For reservations on short notice, contact the 309-732-2277 during regular business hours. We will contact you via email or phone to let you know if space is available. A credit card may be required to hold a reservation.This request does not guarantee a reservation.

8. 
   CONTACT INFORMATION
10. Name of Organization/Purpose
12. Main Contact Name*
14. Main Contact Address*
16. City*
17. State*
18. Zip Code*
20. Phone*
22. E-Mail*
24. 
    RESERVATION INFORMATION
26. Preferred Date of Rental*

    (Rentals are available November 1st - March 15th)

28. Preferred Rental Time

    (Rental fees are $75 per hour with a 3 hour minimum and includes set up and tear down)

30. Total Anticipated Number of Attendees*

    (Maximum 49)

32. How many tables?*

    (Available tables: 4 bar height tables with 3 stools, 4 counter tables with 4 chairs, 2 six foot white resin tables, and 2 eight foot white resin tables. 16 white resin chairs)

34. Will you have decorations?
    -- Select One --YesNo

    No tape allowed.

35. If so, indicate type of decorations
37. Will you have food?
    -- Select One --YesNo
38. If so, briefly describe food provided:

    If catered, list the name of caterer.

40. Are you requesting alcohol?
    -- Select One --YesNo

    (All alcoholic beverages must be purchased from Highland Springs. Requests for alcohol must be made 14 days in advance of rental.)

41. If so, list alcoholic beverages requested.
43. How did you hear about us?
45. COMMENTS
47. *indicates required fields
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

* indicates a required field