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

17. Check-In Representative*

18. Phone*

20. E-mail*

22. Meeting Topic*

24. Expected Number of Attendees*

26. 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.

28. Requested Date of Meeting*
    Requested Date of Meeting

29. Requested Time*
    Requested Time Start Time

    —

    Requested Time End Time

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

30. Would you like to request multiple meeting dates?

    1. Yes
    2. No

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

34. 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. Dry erase board
    11. Podium
    12. Easel
    13. Coffee pot / filters (you supply coffee)
    14. American Flag
    15. None

35. Please select other items you will provide.*

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

36. 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.

38. *What is a hearing loop?

    How a Hearing Loop Works

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

44. FOR LIBRARY USE ONLY

46. Application Approved by:

47. Date Approved:

49. Assigned Room:

    Loup Room North Platte South Platte Niobrara

    Loup Room North Platte South Platte Niobrara

50. Contact Signature:

52. Deposit Paid

    Cash Check

    Cash Check

53. Deposit Returned

    Yes No Deposit Donated

    Yes No Deposit Donated

54. Contact Initials

56. Library Staff Initials

57. Notes:

Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field