Today's date _____________

Organization Name ___________________________________________________

Organization Address _________________________________________________

Organization Phone (day) ___________________ (eve.) _____________________

Contact Person ______________________________________________________

Address ____________________________________________________________

Phone (day) ____________ (eve.) ____________

The Program Room is available for use only during the library’s hours of operation. Set-up may not begin before the library’s normal opening time. All members of the group must vacate the meeting rooms prior to the library’s normal closing time.

Library hours: Monday-Thursday 11 AM- 8 PM, Friday 11AM- 6 PM, Sat. 11 AM – 2 PM; Sun. 1-4 PM . Summer Hours: Closed Sundays May thru September .

Date of Program ____________________________________

Time Requested from:___________ to:__________

(Time requested must include set-up and clean-up time.)

Actual start time of meeting:_ Actual end time of Meeting:____

No Group can reserve more than 6 months in advance; groups are limited to 12 times in a 12 month period.

Program Description

Program Name_________________________________________________________________

The Program Room is 21 ‘ by 21’8”‘ with a maximum occupancy of 30 people. There are no kitchen facilities available. Food and beverages may be provided by the group, but must remain in the Program Room.

Facilities are to be left in clean & orderly condition. The library does not supply pens, pencils, paper, refreshment or coffee supplies or any equipment not listed below. Please make this part of your planning.

Equipment: The following equipment is available for use.

If desired, please select from the following list:

Slide Projector

Easel/Flipchart with Paper

Portable Projection Screen

VCR on cart

DVD player on cart

Vacuum for clean- up

21” TV

Reservations should not be considered confirmed until the library Program Coordinator has notified you.

I have read the Sand Lake Town Library Program Room policy and regulations, and

the organization for which I am the responsible representative will abide by those

provisions.

Signature __________________________________________ Date __________

Title ______________________________________________________________

What name & phone number may the library release to any individuals inquiring about

meetings of your organization in the library?

Name: ___________________________________________ Phone: _____________

Please Print

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For library use only. Program Coordinator _______________________________

Approved _________ Disapproved ________ Date _______________________