Application for Use of Program Room
Name of Artist:
____________________________________________________________
Address: _________________________________________________________________
Tel. #: (___) _________
Date Requested: __________________________ Time: From
__________ To _________
Expected Attendance: _____________________
Brief Description of Program: ________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Refreshments To Be Served?:
Yes _____ No _____
If Yes, please describe: _____________________________________________________
Equipment Needed: VCR & projector _____
Film projector (16 mm) _____
Slide projector _____
Computer/projector link _____
Application to Library Board of Trustees for
Permission to:
_____
Serve alcohol (please give details:___________________
____________________________________________________
The applicant has read and agreed to accept
responsibility for compliance with the
Library's program room policy and
regulations.
Signature of Applicant: __________________________________
Mailing Address: ______________________________________
______________________________________
Return to:
Attention: Pamela Strachan, Library Director