Meeting Room Form

Organization?

Program Title

For Profit or Business? Yes No

Contact Person

Day Phone

Evening Phone

Fax Number

Email Address

Address

City

State

Zip Code

Date and Time Requested	Room Requested
Date	Meeting Room A	(capacity 25)
Set-up Time begins AM PM	Meeting Room B	(capacity 50)
Clean up Time ends AM PM	Meeting Room A&B	(capacity 75)
Total Hours	Number of People Expected

Room Use Fees (For-Profit Only)	Half Day	Full Day
	Up to 4 hours	More than 4 hours
Meeting Room A (capacity 25)	$25.00	$50.00
Meeting Room B (capacity 50)	$50.00	$75.00
Meeting Room A&B (capacity 75)	$75.00	$150.00

Fees payable to the Northville District Library are due prior to the meeting.

Tables (6-six foot tables, 3 per room), chairs, and projection screens are included with the Meeting Room.
Number of Tables Needed?	Number of Chairs Needed?
The following equipment is available but MUST BE REQUESTED WHEN THE ROOM IS BOOKED.

Microphone

Projector (for your own computer)

DVD/Blu Ray

Note: I have read the accompanying Meeting Room Policy as well as this application form and agree, as a condition of and in partial consideration for the use of the meeting facilities, that my organization will leave the room and equipment in the same condition it was prior to our meeting; be responsible for any damage to the facility or damage/loss to any Library equipment; and release/hold harmless the Northville District Library from any and all claims for personal injury or property damage.

Submitted By:

Today's Date:

Completing this form is NOT a guarantee of receiving the meeting room on your chosen date/time.

Your request will be checked against the calendar. All room reservations are first come/first serve. If you choose a date/time that is occupied, the Library will contact you in regards to this. Please ensure a proper phone number and email are included.

FOR STAFF ONLY:	STAFF INITIALS:

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