LILLY
LIBRARY
APPLICATION FOR USE OF MEETING ROOM
Request
is hereby made for the use of the Meeting Room at Lilly Library (Please print
or type)
Date............................ Time needed:
from.............................AM/PM
to.................
.AM/PM
Name
of applicant
..
Organization....................................................................................... Tel ....................
.....
.
Address.............................................................................................................................................
Fax.................................... E-mail
Type
of Organization:
Literary.............
Educational.............. Philanthropic........... Civic.................
Other
(explain)
...............
...
...........................................
.....
.
Are
you a non-profit organization? Yes
..
No
..
Is this event open
to the public? Yes
.. No
..
Activities
to be
conducted...............................................................................................
...
Number of chairs
requested.................................. Number of
tables
Please
note that we currently do not have any AV equipment available. Access to Internet is available in the room:
I
certify that I am an officer of the above named organization; that I have the
authority to reserve the meeting room; and that the above statements are true
to the best of my knowledge and belief.
I
hereby agree that the applicant will be responsible for any damage caused by
the applicants organization to the library premises or furnishings because of
the use of said premises, and agree to pay for said damages as assessed by the
Library Board of Trustees. I have read
and agree to abide by and uphold all rules and policies of the Lilly Library
Association governing the use of library premises.
I agree to protect, save, and keep the Lilly Librarys Board of Trustees, the Library Director, their agents and employees forever free and harmless and indemnified against and from any and all loss, cost, or expense arising out of or from any accident or other occurrence causing injury to any person or property whomsoever or whatsoever as a result of the use of the above premises.
Signature........................................................
Title
.
..
. Date
..
Print
name
..