2. Contact Information
4. Date Submitted*
   Date Submitted
6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Home Phone Number*
16. Work Phone Number
18. Email Address*
19. Cell Phone Number
21. Meeting Information
23. Date Room Needed*
    Date Room Needed
25. Name of Organization*
26. Purpose of Organization
28. Program or Subject of Meeting*
30. Anticipated Attendance*
    Number of People
31. Room Desired*
    -- Select One --Community Room (main floor up to 60 people)Lienhard Room (2nd floor up to 16 people)
33. Time Room Will Be Needed*
    Time Room Will Be Needed Start Date

    Time Room Will Be Needed Start Time

    —

    Time Room Will Be Needed End Date

    Time Room Will Be Needed End Time
35. Time Meeting or Program Will Begin*
    Time Meeting or Program Will Begin

    Time Meeting or Program Will Begin
37. Equipment Needed*

    1. White Board
    2. None
    3. Screen
    4. TV / DVD / VCR
38. Do You Want a List of Related Library Materials Available at The Meeting?*

    1. Yes
    2. No
40. Room Set-Up Needed

    1. Community Room - Auditorium Style chairs only)
    2. Community Room - No Chairs, no tables
    3. Community Room - Seminar Style (chairs and tables, 30 maximum)
    4. Lienhard Room - Boardroom style only
41. Will The Meeting Be Open to the General Public?*

    1. Yes
    2. No
43. Will Refreshments Be Served?

    1. Yes
    2. No
45. If You Selected Yes to refreshments, What Type Will You Be Serving?
47. Additional Comments
49. Submission of this application signifies that I have read and agree to abide by the regulations listed on the meeting room policy statement. *

    1. I agree
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

* indicates a required field