Author: Windows User

APPLICATION FOR LOUTTIT LIBRARY MEETING ROOMS:
Name: ____________________________________ Library Card # REQUIRED: ___________________________
Your address:__________________________________________________________________________________
Mobile phone number: _________________________ Home/Other phone number:________________________
Email address: _________________________________________________________________________________

Room request for: I am the Responsible Party for a Nonprofit Organization or Community Group:
Group Name: _____________________________ Group’s Federal Tax ID#______________________________
I would like to host a Private Party* (See fees below)
Other, please describe: ______________________________________________________

Date Requested: / /23 Start Time: : End Time: :
List ALL activities planned for the space:
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Meeting Room Assigned: Activity Room (Small) Activity Room (Large) Community Center

NO FOOD OR BEVERAGES OTHER THAN WATER ARE PERMITTED IN THE ACTIVITY ROOMS.
Louttit Library Meeting Spaces may only be used in accordance with the attached policies. All requests are subject to approval by the Louttit Library Board of Trustees. Applicant acknowledges receipt of a copy of the attached policies and agrees to their terms. I, the undersigned, have reviewed and agree to all Meeting Room policies and terms of use. Signed:_______________________________________________________________ Date: ________________

TO BE COMPLETED BY STAFF ONLY: W.G. Resident Out of Town Resident <$10 Fines
Designated space: Activity Room Small Activity Room Large Community Center

*FEES: There is a required donation of $150 (nonrefundable cash or check) and a $50.00 damage deposit (refundable, check only, ) for use of the Community Center. Rooms will not be calendared until both fees have been paid, and the application and policies have been reviewed and signed.
Donation CASH or Check # ____________________ Damage Deposit Check# ______________________
(The Donation may be made in cash or by check the Damage Deposit is payable by Check only)

Date Received: ________ Date Calendared:________ Staff Initials ________ 06/22/23 6/2023

LIBRARY STAFF USE ONLY: