Lynnwood Library Meeting Room Use

Lynnwood Library Meeting Room Application

Date of Application: Click here to enter a date.

Name of Organization: Click here to enter text.

Nature and activities of Organization: Click here to enter text.

Purpose of meeting(s): Click here to enter text.

Meeting Date(s): Click here to enter a date. Enter another date here.

Meeting Time: Click here to enter text.

Beginning: Click here to enter text.(AM/PM)

Ending: Click here to enter text. (AM/PM)

Expected Attendance: Click here to enter text.

Please read and initial each item:

☐I have read and agree to comply with the Lynnwood Library Meeting

Room Use Policies.

☐Our meeting will be open to the general public.

☐I understand that my name and telephone number may be given to

members of the public who express interest in attending or

observing our meeting(s).

☐I understand that while using the Meeting Room, no admission may be

charged for admittance.

☐If I no longer need to use the Meeting Room, I agree to provide the

Library with at least 24 hours advance cancellation notice.

☐I understand that failure to comply with the Lynnwood Library Meeting

Room Use Policies could result in the loss of access to the Meeting Room.

☐I agree to assume full responsibility for any loss or damage to the

Meeting Room.

By signing this form, I acknowledge that I am authorized by my organization to take responsibility for my organization’s use of the facility and to indemnify and hold harmless the City of Lynnwood and the Lynnwood Library for all losses resulting from my organization’s use of the Lynnwood Library Meeting Room.

Signature of Authorized Person: Click here to enter text.

Please Print Name: Click here to enter text.

Date:Click here to enter a date.

Contact Information:

Name of Organization: Click here to enter text.

Authorized Person:Click here to enter text.

Title: Click here to enter text.

Mailing Address: Click here to enter text.

City: Click here to enter text.

State: Click here to enter text.

Phone Numbers:

Day: Click here to enter text.

Evening: Click here to enter text.

Fax: Click here to enter text.

Email: Click here to enter text.

______

STAFF USE ONLY:

☐Permission Granted

☐Permission Not Granted

Date: Click here to enter a date.

Signature of Managing Librarian/Designated Staff:

Click here to enter text.

______

Approved this ______day of ______, 20______

______

President of the Lynnwood Library Board Printed Name

______

City of Lynnwood Mayor (or designee) Printed Name