| Organization Name: | |
Name of Individual Filing Application: | |
| Address: | |
| City: | |
| State: | |
| Home Phone: | |
| Work Phone: | |
| Email Address: | |
| May we give contact information to persons wanting to contact your group? | Yes No |
| Topic or Purpose of Meeting: | |
| Estimated Attendance: | |
| Do you have a press release? | Yes No |
| I acknowledge that I have read the Community Room Policy and agree to the terms listed therein (please initial): | |
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| One-Time Uses: | |
| Date of Meeting: | |
| Time of Arrival: | |
| Time of Departure: | |
| Speaker(s): | |
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| Recurring Meetings: | |
| Recurrence: | |
| Time of Arrival: | |
| Time of Departure: | |
| Beginning Date: | |
| Ending Date: | |
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| Equipment Needed: | Podium w/ Microphone TV/DVD LCD Projector (for Laptop) Dry Erase Board Opaque Projector No Equipment Required |
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