Meeting Room Reservation Application

Non-Profit Organization*

Name*

First Last

Office Held in Organization*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Telephone*

(In case the library needs to contact you regarding your reservation.)

Cell Phone

Email*

Website

Library Card Number*

(Must be resident card or full-service non-resident card.)

Describe the nature and/or mission of the organization.*

(All information on this form is considered to be in the public domain.)

Describe the nature and/or purpose of this meeting being scheduled at GPL. Please be specific.*

Room, date and time requested – be sure to include time for set-up and clean-up:*

(click the + symbol on the right to add multiple meeting dates)

Room	Date	Time (begin – end)	Number of People Expected

Prior to the meeting, the organization is responsible for setting up any additional tables and chairs that may be needed. (The Auditorium normally has 50 chairs set up.) After the meeting, the organization is responsible for returning the room to its original configuration. The Library will make sure the number of requested tables and chairs are readily available.

Equipment:*

(click the + symbol if multiple meeting dates were requested above)

Chairs (indicate number)	Tables (indicate number)	Lectern	Microphone	Projector	Other

Refreshments may be served in the Schrock Auditorium, but not in Meeting Room A/B. Such items are limited to finger foods and nonalcoholic beverages. Please do not serve red punch. Use of the kitchen is available upon request.

By signing this form, I acknowledge that I have read the meeting room policy and the regulations stipulated by the Goshen Public Library Board, and I agree to take responsibility for ensuring that all attendees abide by them.

I declare that the organization or group listed above is non-profit and noncommercial and is responsible for any infraction of the regulations and any damages to library property incurred during or in connection with the use of the meeting rooms.

I am the only person authorized to schedule meetings using this application.

Signature*

Date*

If any parts of the application are left blank, a representative may contact you for more information.

Name

This field is for validation purposes and should be left unchanged.