Reservation Dates: ___________________________________

Reservation Time: ____________________________________

Group Name:___________________________________________

SET UP:

   #Tables: _____________________

   #Chairs: _____________________

Today's Date: _______________________

Name of Organization/Group:_________________________________________

Meeting purpose or function:________________________________________


Having read the Meeting Room Policy, my group agrees to abide by it, and the undersigned will be personally responsible for any infractions thereof, and any damages.

Signature:_____________________________________________

Name (please print):___________________________________

Address: ______________________________________________

Phone:___________________________


Approved by:_________________________________________________________


You may submit application for approval by returning it in person or by FAX.