Conference Room Registration Form

Date of Meeting*

Registration Name*

First NameLast Name

Time*

:HourMinutesAM/PM Option

until

until :HourMinutesAM/PM Option

Organization

Number Expected

{Limit of 20}

Purpose of this Meeting

Person in Charge (if different}

Phone Number*

Area CodePhone Number

E-mail*

Please Check Items Needed:

Coffee Maker / CarafeElectric TeapotDVD PlayerTV / Cart

FEES:*

$10.00 per Hour - Non-Profit Organization may use the Conference Room for up to 4 hours on a day.$15.00 per Hour - Any other organization or individual may use the Conference Room for up to 4 hours on a day.

Waiver of Liability: In the event of inclement weather, utility outage, or other emergency, the library director may cancel scheduled meetings by notifying the person who made the application. The library shall have no liability for any loss or expense if the applicant chooses not to reschedule. Persons, organizations, groups, or businesses using the conference room agree to hold the NADL harmless from injury, loss, damage, liability, costs, or expenses that may arise during, or be caused by, use of the library facilities or grounds. The undersigned representative of the group reserving the room understands and accepts these general conditions.

Further, I understand that my organization is financially responsible for the repair of damage to rooms, furnishings and the repair or replacement of any of the equipment listed above that is damaged or missing following this session. I also understand that my organization is responsible to clean up according to the attached checklist. I hereby apply for use of the library’s meeting room and agree to abide by the policies furnished to me, and to give notice of cancellation within two working days prior to the meeting to the office of the Director.

Today's Date

Signature*

Type Name of Registrant

Conference Room Reservation