|
|
|
|
WESTERN CARTERET PUBLIC LIBRARY APPLICATION FOR USE OF THE COMMUNITY ROOM Name of Group/Individual: ____________________________________________________ Name of Applicant: __________________________________________________________ Address: _____________________________________________________________ Telephone: ______________________ Type of Activity: Lecture ____ Film ____ Meeting ____ Music ____ Other, please specify: ___________________________________________________ Person in charge if different than applicant: ________________________________________ Address: ______________________________________________________________ Telephone: _______________________ Subject of Activity or Program: __________________________________________________ List library equipment needed: ___________________________________________________ Date Room is Wanted: __________________ Program Starting Time: ___________________ Room Use to be scheduled From: ___________ Until: ________________ (includes time for set up before program and clean up afterwards) Will refreshments be served or will there be cooking? _______ (If yes, group or individual is responsible for cleanup.) I have read the “Policy and Regulations for Use of the Community Room” and agree to the regulations stated therein. _______________ ______________________________________________________ Date of application Signature of Applicant
Library Use Only: Approved ____ Date Notified ____ by ______ Actual Attendance: ____________ 230 Taylor Notion Rd., Cape Carteret, NC 28584 Tel: (252) 393-6500 Fax: (252) 393-6660 |
