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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