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Exhibit 4, Application for Use of Meeting or ICN Room

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Application for Use of Meeting or ICN Room


Date:______________

Name of organization:_____________________________________________________

Contact person:___________________________________________________________

Address:________________________________________________________________

Telephone:_______________________________________________________________

Date of meeting___________________________________________________________

Time of meeting: From _____________________to______________________________

Number of persons expected:________________________________________________

Will refreshments be served?    Yes______   No________

The person who signs this reservation form shall be responsible for problems or costs resulting from the specified use.  Groups accept responsibility for the repair or replacement of damaged or missing facilities or equipment.  Children’s groups must be supervised by two adult sponsors.  The door shall be locked and key shall be promptly deposited in the book depository at the conclusion of the meeting or use of room.

I have received a copy of the Meeting Room Policy and understand and will comply with all its regulations.

                                                            Signature:_______________________________________

                                                            Address:________________________________________

                                                            Telephone:_______________________________________

The Eldora Library Board of Trustees of the City of Eldora is not responsible for accidents, injury or loss of individual property while using the Meeting or ICN Room.

 Exhibit 4