Application for Library Meeting Room Use


Name of organization: ____________________________________ Date of Application: ________________

Address of organization: _______________________________________ Telephone: ___________________

Purpose/function of organization: _____________________________________________________________
________________________________________________________________________________________

Name of individual filing application: __________________________________________________________

Office held in organization: _________________________________________________________________

Address: _________________________________________________ Telephone: _____________________

Name of individual responsible for meeting: _____________________________________________________

Office held in organization: _________________________________________________________________

Address: ________________________________________________ Telephone: ______________________

Purpose of use: ____________________________________________________________________________
_________________________________________________________________________________________

Topic: ___________________________________________ Speaker: ________________________________

Date of meeting: _____________ Time: from_______to _______ Attendance expected:_____ Actual:_____

IRS Exemption Certificate 501(c)(3) received: _______yes ________no


A G R E E M E N T

The charge for the use of the room is payable within 7 days of approval of application. If payment is not received, approval is rescinded.

WE, THE APPLICANT AND/OR THE RESPONSIBLE INDIVIDUAL, HAVE READ AND AGREE
TO ABIDE BY THE REGULATIONS OF THE LIBRARY GOVERNING PUBLIC MEETING ROOMS.

  ______________________________________________
Signature of applicant/responsible individual

LIBRARY USE ONLY

Distribution: Make copy for Applicant.
Send original to Branch/Downtown Library.

If not approved, attach a statement and forward to Library Director.

If approved, forward to Library Director after the meeting is held.

______Approved _______Disapproved


Amount Paid: ______________

Branch: ___________________

 

____________________________________________________
Authorized signature                                                Date