Meeting Rooms Form

Departments Forms & Applications Friends Staff Trustees

Application for Use of the Meeting Rooms

To apply for use of the Library's meeting rooms:

First, read our Meeting Room Policy to be sure your group is eligible to reserve a Meeting Room.

Second, print this page.

Third, call the Chelmsford Public Library at (978) 256-5521 to confirm that the date you want is available.

Once you have the confirmed date, send the completed form to the Library by fax (978-256-8511), mail or in person to 25 Boston Road, Chelmsford, MA, 01824.

Date ____________________________

Organization _________________________________________________________________

Authorized Representative ____________________________________________

Day Time Phone ___________________________________

Complete Address ________________________________________________________________

Email Address _________________________________________

Type of organization:

Educational	_____
Cultural	_____
Civic	_____
Other (please explain)	_____

Purpose of the organization: ____________________________________________________________

___________________________________________________________________________________

I certify that I _________________________________ (your name) am an authorized representative of

_____________________________________________ (organization) and have read and agree to abide by and uphold all policies and regulations governing the use of library premises or equipment. I understand our organization must receive written permission from the Library Trustees to waive the Meeting Room Guidelines that state, "All meetings are free and open to the public" and No admission fee may be charged, no business, food or donations may be solicited, directly or indirectly, and no merchandise or beverages may be sold by any group without written permission in advance from the Board of Trustees or the Library Director."

I want to reserve the

McCarthy Meeting Room A (kitchen side holds 25 people auditorium seeting) _______
McCarthy Meeting Room B (window side holds 50 people auditorium seeting) _______
Whole McCarthy Meeting Room B (holds 75 people auditorium seeting) _______
Conference Room (holds 12 people at a conference table) _______

Please list below your first, second for meeting dates. (For example, Tuesday, November 16 from 7-8:45 pm or
3rd Tuesday of each month from 7-8:45 pm.)

Date(s)

Time Meeting Starts

TIme Meeting Ends

Maximum # of Attendees

1st Choice

2nd Choice

3rd Choice

__________________

___________________

_________

A custodial fee of $25 will be charged for any hour or part of an hour after 9 pm. Checks should be made payable to the Chelmsford Public Library.

Light refreshments : ______ will be served -or- ______ will not be served.

Please check off any items you are requesting for the above meeting date:

______	Lectern	______	5' long table (max. 10)
______	Public Address system	______	Stackable chairs (max 72)
______	TV/VCR	______	Extension cord
______	Piano	______	White board/flip chart
______	Slide projector	______	Projection screen
______	10-cup coffee maker (max. 2)	______	Vacuum cleaner
______	100-cup coffee maker	______	Multi-media projector - can be used with your own laptop
______	Easel stand

Note: no stove or microwave available.

McCarthy Room Seating Arrangement:

______	Chairs in rows	______	Tables with chairs
______	Circle of chairs	______	Other (please include a diagram)

Signature: _____________________________________________________________

Date ______________________________

Please return this application form to the Library in person, by mail or by fax. A confirmation will be returned. Filing an application does not guarantee a room - the Library must grant confirmation. For help with the meeting room application or more information, please contact Nancy Rager at 978-256-5521, x100, or send her an email.



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