Form_meeting_room_application_2025.xlsx

	A	C	E	G	H	I	K	M	O	Q	R	S	T	U	W	AA	AD	AE
1	Jefferson County Library
2	Meeting Room Application
3						Application must be filled out in its entirety												10/30/25
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5	Organization:
6	Contact Person:
7				Name									Title
8	Address of Organization or Contact Person:
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10							Street Address Only
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12			City								State					Zip Code
13	Telephone Numbers:					Day:								Evening:
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15	Email Address:
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19	Requested Date:
20	Requested Time:				From:					am/pm				To:			am/pm
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23	Purpose/Function of Meeting:
24	*Age Recommendation:___________________________________														Anticipated Attendance #:
25	Will Refreshments be Served?							Yes	$15 fee applicable if refreshments served								No
26	Library Equipment to be Used:
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29	I have read the Community Meeting Room Policy. We,
30															Organization name
31	agree to abide by these set rules and regulations. I accept responsibility for the repair of damaged equipment
32	or the building interior, or the replacement of missing equipment of the Jefferson County Library District.
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34	Signature											Date
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37	Monthly Users: A new application form must be submitted annually.
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41	Office Use Only:						Approved						Denied			$100 Fee Paid
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43	Authorization:													Date:
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46		*Age recommendations for the stated purpose of non-library related meetings are required on publications and failure to advertise the age recommendation as required by the 15 CSR 30-200.015 could result in the group being prohibited from using the space in the future.
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