I understand and agree to abide by the Hazen Memorial Library Meeting Spaces Policy as set forth. I accept personal responsibility on behalf of my organization for use of a Meeting Space. I understand that failure to notify the library about cancellations at least 24 hours in advance will result in denial of future requests.  I am aware of reduced capacity and accommodations in the library meeting spaces at this time.

Name (Please Print):____________________________________________________________

Address (Street, City, Zip):______________________________________________________

Telephone Number (with Area Code):_____________________________________________

Emergency Contact Name:______________________________ Number:________________

Representing (Organization Name):_______________________________________________

Room requested:

Quiet Study Room (Max capacity=4)_______________(# attendees);

-or-

Large Meeting Space (Max capacity=20)____________________(# attendees)

Date and Time Requested:_______________________________________________________

Purpose of Meeting:____________________________________________________________

____________________________________________________________________________

Special Requirements (Use of A/V equipment, number of tables, chairs):

____________________________________________________________________________

____________________________________________________________________________

Signature:__________________________________________________________________

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FOR LIBRARY USE ONLY

APPROVED Y_____ N_____ Date_________________Notified:________________________

Name:_______________________________________________________________________

Signature:__________________________________________________________________

Comments:___________________________________________________________________