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:_____

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 If payment is not received, approval is rescinded.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.