Name of Group or Organization:
 Name of contact:
 Daytime Phone:

We are applying for use of the following checked meeting room(s). We have read the Policies and Regulations and agree to comply with them and understand that failure to comply with them could result in revocation of privileges to use the meeting rooms.

 Date(s) and hour of meeting(s):  (Include time for set-up and break down in either Hirsch Room. No set-up required for the 16 seat Penzel Room.)
 Probable Length:
 Probable Attendence:
 Nature of meeting:
 Purpose and function of organization:

Technology Needs:
(Projector, projection screen & DVD player available in each room - Please bring your own laptop for PPoint presentations and allow extra time for set up and testing prior to your event.)

Refreshments to be served:

I understand that my reservation is not scheduled until confirmed by Library staff.
  Initials of Applicant: