Meeting Room request

Date / Time of Requested Use *

Date

Time

Name of Organization

Address *

Address Line 1

City

State

Zip Code

Contact Person / Title *

Contact Phone! *

Contact Email *

Purpose of Meeting *

Will refreshments be served? If so, please describe in detail. *

What type of Library Equipment will you be using? If applicable, an Equipment Loan Request from completed by applicant and staff must be on file. *

None
Laptop connected to TV including remotes
Podium

I have read the Middletown Public Library Meeting Room Use Policy and agree that my organization will abide by this policy with regard to the use of the Meeting Room - SIGNATURE REQUIRED, PLEASE SIGN BELOW *

Sumitted Date

Name Printed *

First

Last

Title / Position: *

Middletown Public Library Authorized Signature

Approved Date