Meeting Room Use Form

MEDWAY PUBLIC LIBRARY
26 High Street, Medway MA 02053
MEETING ROOM USE APPLICATION

NAME OF ORGANIZATION: _________________________________________________________

PERSON FILING APPLICATION: _____________________________________________________

ADDRESS: _________________________________________________________________________

PHONE: ________________________ EMAIL: ____________________________________________
(Circle preferred contact: PHONE/EMAIL)

ROOM REQUESTED:

__ Cole A
(Up to 25) __ Cole B
(Up to 50) __ Cole A+B
(Up to 100) __ Conference Room
(Circle one: Up to 10/12/16) __ Story Room / Other
(Limited use)

DATE(s) REQUESTED: ______________________________________________________

TIME: _________ to _________ GROUP SIZE: _________ FEE: _______________
Fee: We will pay the fee of $25 per Booking Date assessed to "for profit" groups, organizations or companies.
Waive fee: Our organization is funded primarily by donations, fund-raising or member dues.

EQUIPMENT REQUESTED:

__ Movie/Computer Projector __ Connection for computer __ Blu-Ray/DVD Player __ VCR Player __ Movie Screen __ Movie/Music Speakers

PLEASE READ THE FOLLOWING AND SIGN BELOW
I have read, understand the attached regulations governing the use of meeting rooms, and agree to comply with these regulations. I am aware that a Booking Date is any period up to four hours, and longer meetings will be charged as multiple Booking Dates. I understand that if special permission has been granted to use Library facilities beyond regularly staffed hours, I will have to arrange and pay for an approved after-hours steward. This application is subject to Library Director's approval.
* All fees are due prior to function. Make checks payable to: Medway Public Library.

Applicant Signature __________________________________ Date_____________

FOR LIBRARY USE ONLY (Rev. 11/29/2012)

THIS ROOM USE: ___ APPROVED ___ DENIED LIBRARY STAFF: ________

Room Fee: ____ Booking Dates ($25 each) = $________
TOTAL DUE* = $________