MERCER COUNTY PUBLIC LIBRARY REGISTRATION FORM FOR MEETING ROOM USE

Name of Organization/Individual:                                                                                 

Dates Requested:                                                                                      

Beginning Time:                                                              Ending Time:                                                            

Purpose of Meeting:                                                                                                                                          

                                                                                             If Children, #
Estimated Attendance:                                                     of Adult Sponsors:                                                
(Please notify us of any  significant changes)

Signature and Title of person Agreeing to the Meeting Room Policies & completing this form

I have been given a copy of the Meeting Room Policies, and agree To follow them and will assume

responsibility for the room or will Appoint                                                                in my place.

Signature:                                                                                                                                                         

Address:                                                                                                                                                                                                                

Home Phone:                                                                                       Other Phone:                                                                                  

                            Registrant has received a copy of the Meeting Room Policies.

Date:                                                   Staff Signature: