Form Center

Meeting Room Reservation Form

2. Organization Name*

4. Mailing Address*

6. City*

7. State*

8. Zip Code*

10. Contact Person*

11. Phone*

13. Email Address*

15. Will you be the person checking in for the meeting?*

    1. Yes
    2. No

16. Do you have a Kearney Public Library card?

    1. Yes
    2. No

18. Getting a library card
    http://cityofkearney.org/1603/Apply-for-a-library-card

    We do ask that you register for a Kearney Public Library card prior to the meeting. They are free. All we require is a valid driver's license and something with the current address (if your ID does not show it). Please come a few minutes before your meeting and our staff will be happy to assist you with this or visit the link above to apply online and pick up your card on the day of your meeting.

20. Check-In Representative

21. Check-In Representative Phone

23. Check-In Representative Email Address

24. Does the check-in representative have a Kearney Public Library card?

    1. Yes
    2. No

26. Getting a library card
    http://cityofkearney.org/1603/Apply-for-a-library-card

    We do ask that the check-in representative registers for a Kearney Public Library card prior to the meeting. They are free. All we require is a valid driver's license and something with the current address (if their ID does not show it). They may come a few minutes before the meeting and our staff will be happy to assist them with this or visit the link above to apply online and pick up the card on the day of the meeting.

28. Meeting Topic*

30. Expected Number of Attendees*

32. Meeting Room Hours
    Meeting room hours are 9:30am-8:45pm Monday through Thursday, 9:30am-4:45pm Friday and Saturday, and 1:30pm-4:45pm on Sunday. The library is closed on public holidays.

    Meeting room hours are 9:30am-8:45pm Monday through Thursday, 9:30am-4:45pm Friday and Saturday, and 1:30pm-4:45pm on Sunday. The library is closed on public holidays.

34. Requested Date of Meeting*
    Requested Date of Meeting

35. Requested Time*
    Requested Time Start Time

    —

    Requested Time End Time

    Please include set-up and tear-down time in your request.

36. Would you like to request multiple meeting dates?

    1. Yes
    2. No

38. Please list the additional dates/times you'd like to request meetings.

40. Please select any amenities your meeting will require.*

    1. Extra tables / chairs
    2. Projector / screen
    3. Computer
    4. VGA/HDMI laptop connection
    5. Microphone
    6. Portable hearing loop*
    7. Portable speakers
    8. Extension Cords / Power Strips
    9. Conference call phone
    10. Webcam
    11. Dry erase board
    12. Podium
    13. Easel
    14. Coffee pot / filters (you supply coffee)
    15. American Flag
    16. None

41. Please select items you will provide.*

    1. Food
    2. Laptop
    3. Projector
    4. None

42. Agreement to Meeting Room Policies*

    1. Agree
    2. Disagree

    As an authorized adult representative of the above organization, by selecting "agree", I hereby apply for the use of the meeting room as indicated above. I have read the policies and rules governing the use of the meeting room facilities and agree that they will be carefully observed. If a meeting is cancelled, I agree to notify the library as far in advance as possible.

44. *What is a hearing loop?
    How a Hearing Loop Works

46. Please Note: You will receive a confirmation e-mail when your meeting has been approved.

50. FOR LIBRARY USE ONLY

52. Application Approved by:

53. Date Approved:

55. Assigned Room:
    Loup Room North Platte South Platte Niobrara

    Loup Room North Platte South Platte Niobrara

56. Contact Signature:

58. Deposit Paid
    Cash Check

    Cash Check

59. Deposit Returned
    Yes No Deposit Donated

    Yes No Deposit Donated

60. Contact Initials

62. Library Staff Initials

63. Notes:

Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

* indicates a required field