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APPLICATION FOR THE USE OF THE

MEETING ROOM

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Name of Organization_____________________________________________________________

Person making reservation_________________________________________________________

Address________________________________________________________________________

Telephone __________________________________Date of Meeting_______________________

Time of Meeting: From _________________________am/pm _______________________am/pm

Meeting Room to be Reserved_______________________________________________________

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EQUIPMENT REQUIREMENTS   (Circle one or more)

 

slide projector                          coffee pot                               screen     

opaque projector                     overhead project                    VCR/TV     

Dry Erase Board                      Filmstrip projector                   Easel      

16mm projector                       Other_______________________________

 

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AGREEMENT

 

I have read the rules and regulations governing the issuance of this application and understand them.  Furthermore, I, the undersigned, personally and officially for______________________________ agree to abide by the library regulations and to assume complete responsibility for any damages and/or losses to the room.

 

I understand that my deposit of $25.00 will be refunded to me if the room is left clean and undamaged, and if all attendees, including children, abide by the regulations for the use of the room.  In case of damages in excess of the deposit, I will be responsible for the actual cost of repair or replacement, and such amount shall become immediately payable.

 

I understand that I can reclaim the $25.00 deposit refund within 30 days of the meeting date, and if I have not done so by then, the deposit will revert to the Library.

Date of application/deposit payment_________________________________________________

Signed_________________________________________________________________________

Approved by (staff)_______________________________________________________________
Deposit refunded __________yes __________no ___________________date _________________