Meeting Room Request

 

Name of Organization:_________________________________________________________
(Please indicate the meaning of any initials or acronyms)

Event (Describe activity):_______________________________________________________

Date or dates of event: ___________________________________________________________

Time room is needed: __________________________________________________________________
(include time to set up and clean up)
Note: You may not come in to set up before this time. Opening and 15 minutes before closing are the normal limits of scheduled time for meetings without incurring fees.

    Library hours:
    • 10 a.m. - 7:45 p.m. Monday through Thursday*
    • 10 a.m. - 5:45 p.m. Friday
    • 10 a.m. - 4:45 p.m. Saturday
    • 1:00 p.m. - 4:45 p.m. Sunday
    *4th Thursday of the month Noon - 7:45 p.m.

Time event or meeting is actually scheduled: ________________________________________________ (this will appear on our posted room schedule)

Expected attendance: __________ Number of meeting rooms needed: 1 or 2 (circle one)

Circle space desired. Elm Meeting Room - Walnut Meeting Room - Children's Program Room - Amphitheater (Note: The Amphitheater needs senior staff approval.)

List any equipment requests: _____________________________________________________________

I have read the Use Policy Statement and Operational Rules and Regulations and agree to abide by them. In addition, I will be responsible for the conduct of persons present at our event and will assume financial responsibility for any damage to or lost of West Lafayette Public Library property due to my group's occupancy of any Meeting Room. (Note: The person applying must have a valid unencumbered West Lafayette Public Library card.)

Signature of person applying:_______________________________________________

Name and Affiliation of person applying:____________________________________________________

Library card number of person applying: 2 1951 00 __ __ __ __ __ __ __

Address:____________________________________________________________________

Telephone number:___________________________________________________________

Work telephone number:______________________________________________________

Email address:______________________________________________________________

Please indicate prefered method of communication.___________________________

Date:_______________________________________________________________________

Meeting date(s) are NOT set until you receive confirmation back from the library. Please call if you do not get a confirmation back within one week by mail or 2 days by fax. Immediate confirmation available in person only.

PAYMENT(must be arranged and paid at time of reservation)

  • Private Party fee $25/hour (minimum of 2 hours)
                    • _______
  • After hours fee $25/hour
                    • _______
  • Equipment use fee $25/4 hours
                    • _______
  • Donation
                    • _______
  • Total
                    • _______

Payment may be made by:

  • Cash:
  • Check: Check Number: _________
    Please make checks payable to the West Lafayette Public Library
  • Credit Card: Visa______ MasterCard______
    • Credit Card Number: ________________________________ Exp.Date: __________
    • Print name of card holder:______________________________________________
    • Signature of card holder:________________________________________________

LIBRARY USE ONLY

Name of staff member accepting form.______________________________________________

Signature of confirming staff member:______________________________________________

Date of confirmation: ______________________________________________

Please deliver in person, by fax or by mail to:
Meeting Room Request
West Lafayette Public Library
208 West Columbia
West Lafayette, IN 47906
Phone: 765-743-2261
Fax: 765-743-0540