APPLICATION FOR USE OF MEETING ROOM

Application must be signed by an adult and submitted before use of the room.
Date of request: _______________________ Day of the week: ___________________

Time: from _____________ to ____________

Name of organization: ______________________________________________________

Name of person filling out form for organization: ______________________________

Position in group: ( ) Officer ( ) Member

Address: ____________________________________________________________________
Phone number: _______________________

Activity/subject planned: ____________________________________________________

Brief description of materials or literature to be distributed: _____________________
_____________________________________________________________________________
Will refreshments/food be served: ( ) yes ( ) no

I have read Polo Public Library’s meeting room policy and agree to leave the room clean and in the orderly condition in which it was found. I agree to pay for the cost of repair or replacement for any damage to the facility or equipment. The library is not responsible for damage or loss of materials used or left in the building by the group or organization.

By submitting the request, I am assuring the library that the above information is correct and that any advance publicity should in no way involve the library other than as a place of meeting. I realize violations of the rules will result in the cancellation of the meeting and possible repercussions in scheduling future use of the room by this group or individual.

Signature: _____________________________________ Date: _______________________

Library use only –

Date: ____________ ( ) Approved ( ) Not Approved by _________________________