GPL Meeting Room Application

MEETING ROOM RESERVATION FORM (**Note we will be going to an new online room reservation system in the near future. )
            Email form to
Please Print Clearly
Date of Application: __________________________________________________
Name Organization: __________________________________________________
Type of Organization:
            If nonprofit, please enter your IRS Tax ID #: _________________________
            If for-profit, please attach a certificate of liability insurance
Type of meeting: _____________________________________________________
Date and time (start & end): _____________________________________________
Anticipated attendance: ________________________________________________
Meeting room size requested (medium or large): _____________________
Number of tables required: _____________________________________________
Number of chairs required: _____________________________________________
Will you be using the kitchen facilities? Yes______No ______
Please list any equipment (such as audio-visual) you will be providing:
Contact Information:
            Name: _________________________________________________________
            Address: _______________________________________________________
            Telephone: _____________________________________________________
            Email: __________________________________________________________
I have read the policies governing the use of the Community Room and hereby agree, intending to be legally bound, for myself, the organization, the membership of the organization, and its guests, to adhere to and be bound by said policies, the terms, conditions and obligations of which are herein incorporated by reference as fully as though they were set forth at length herein, and acknowledge that the Library is relying upon this agreement in permitting the use of the Library Community Room. I also agree that I will make all members and guests aware of said policies of the Library Community Room.        
The above organization hereby agrees to indemnify and hold harmless the Georgetown Public Library from any loss, damage, or liability, including but not limited to court costs and reasonable attorneys fees,arising from its use of the Georgetown Public Library facilities. The undersigned represents to the Georgetown Public Library that he/she is authorized to bind the above organization to this agreement. The Georgetown Public Library encourages users to consult their insurance advisor to ensure appropriate coverage for this obligation is in place.  
__________________________   ___________________________   ___________
Signature of Applicant                   Printed Name of Applicant                 Date
or Authorized Representative         Title:______________________