| Date: _________________ |
Branch: ________________________________
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| Name of Organization |
________________________________________________________
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| Type of Group: |
___ Library Sponsored |
___ City-Job Order ________ |
___ Not For Profit |
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___ Fee (Event, Private, Church, Commercial, Fund-raising) |
| Date |
Start Time |
End Time |
No. Attending |
Room |
Program Purpose |
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The policy governing the use of the Meeting Room has been read, understood, and will be followed. I understand that failure to notify the Branch Manager (for Central Library contact Circulation section supervisor) in writing of cancellation at least two weeks prior to an event may result in forfeiture of deposit and fees and/or future right of use. I relieve the City of San Diego of liability attendant on this use. Failure to comply with any of the stated regulations will result in the immediate cancellation of the booking and forfeiture of any funds received, and may lead to suspension of meeting room use.
Note: Art and other forms of exhibits may be installed in the meeting room that some people may find objectionable. If this is of concern to you, or to determine the content of the exhibit for the date(s) you are booking the meeting room, please discuss this with the Branch Manager. All fees are subject to change without notice. Also, unless otherwise arranged, all organizations and attendees must exit the building 15 minutes prior to closing.
| Applicant |
____________________________________ |
Home Phone (____)____________ |
|
(Name and Title) |
| Address/M.S. |
________________________________ |
Work Phone _________________
E-mail _________________
Fax Number _________________ |
| __________________________________________________________________________ |
| City | State | | Zip Code |
__________________________________________________________________________
Local Contact Name/Address/Telephone Number (Required) |
| |
| Signature _____________________________________ |
Date ________________________ |
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RECEIPT FOR USE OF MEETING ROOMS
| Date Use Fees Paid _____________________ |
Amount ________ Check No. _________ |
| Date Damage/Cleaning Deposit Paid ________ |
Amount ________ Check No. _________ |
| Received by __________________ |
Date Staff assigned ________ Name _________ |
Comments
___________________________________________________________________________
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PATRON RECEIPT FOR USE OF LIBRARY MEETING ROOMS
| Date Use Fees Paid ________ |
Amount _______ |
Check No. _______ Received by _______ |
| Date Damage/Cleaning Deposit Paid ______ |
Amount _____ |
Check No. _____ |
Received by _____ |
| Scheduled Date & Time of Meeting _______________ |
Room _______ |
Branch _______ |
From Department Instruction 21-15 APPENDIX A
Effective June 2005
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