Application for Use of the Meeting Rooms

Date of Application ______________ Room Requested_________________

Date of Meeting(s)__________________ Time of Meeting(s)______________

Organization__________________________________________________

Insured by__________________________ Agent/Company (certificate attached)

Approximate attendance_________________________________________

Name of Individual Representing Organization_________________________

Address_____________________________________________________

Telephone: (home)____________________  (work)___________________

E-mail:______________________________________________________

I understand that my organization will be responsible for any damage incurred;
that the guidelines for meeting room use must be adhered to; and that our
continued use of the meeting rooms depends upon our ability to follow these guidelines. I have received a copy of the guidelines and have read it before completing this application.

Signature___________________________ Title_____________________

Please complete this application and return it to the Library Secretary, Cora J. Belden Library, 33 Church Street, Rocky Hill, CT 06067. It must be signed and returned to the library before the room is used.

Approved by the Library Board of Directors 3/9/98; Amended 8/21/06

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