First Name *

Last Name *

Email *

Organization *

Phone *

Are you a BelCham Member? *

Enter required value Yes No I'm not sure

Workspace request / What are you looking for?

If you are requesting an office or meeting room, kindly provide names of additional guests (up to 3) for security purposes. Office reservations without additional guest names are unable to be honored due to building access rules. 

If you are requesting an Event/Boardroom Pass, we will follow up with you by email to collect all attendee names & contact information.

Atelier Day Pass Atelier Week Pass Atelier Meeting Room Pass (hourly or daily) Atelier Event/Boardroom Pass (hourly or daily) Information on monthly memberships

Please enter the names of your guests here - separate names with a comma:

Please provide for each guest their first & last name, phone number, and email address. 

Please enter your reservation date (hours of operation: 8.30am ET-7pm ET) *

If you are selecting a multi-day pass, please select the first date of access

I have not been diagnosed or been in contact with someone diagnosed with Covid19 in the last 14 days *

Enter required value True False

I have not shown symptoms of Covid19 or had close contact with anyone exhibiting in the last 14 days *

Enter required value True False

I do not have a cough, fever, chills, shortness of breath, or loss of taste or smell *

Enter required value True False

I have not travelled outside of my immediate daily routine in the past 14 days *

Enter required value True False

If I show symptoms of covid19 in the run up to my workspace reservation I will notify BelCham *

I will do so immediately by emailing info@belcham.org 

Enter required value True False

I will follow BelCham health guidelines to keep myself, coworkers and all others around me safe *

Enter required value True False

Other comments or space needs