Honeoye Public Library
Community Meeting Room Application
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Name of Group
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Authorized Group Representative
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Phone Address
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Date of Meeting Start Time End Time
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Purpose of Meeting
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Estimated Attendance
___Video/DVD ___LCD Projector ___Laptop ___Training on Equipment
The undersigned, on behalf of the above named organization, hereby indicates that he/she has read & agrees to comply with the Honeoye Public Library Meeting Room Policy & Guidelines. The undersigned assumes all and exclusive responsibility for the preservation of order and the sole responsibility for any injury to persons, damage to Library facility or loss of personal property that may result from this use. The Honeoye Public Library is not responsible for any materials, equipment or personal belongings left in the Library.
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Date of Application Signature of Authorized Group Representative
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Date of Approval Authorized HPL Signature
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Comments /Incidents
(8/2013)