Real County Public Library Application for Use of Facilities Name of Organization(Required)Organization Website(Required)Date of Event(Required) MM slash DD slash YYYY Event Start Time(Required) Hours : Minutes AM PM AM/PM *includes set upEvent End Time(Required) Hours : Minutes AM PM AM/PM *includes takedown and cleanupType of Event(Required)Estimated Attendance(Required)Select one of the following: For-Profit Entity Non-Profit Entity RESPONSIBLE PARTY (Person Signing the Agreement)Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email address(Required) Contact phone(Required)Room Requested(Required) Board Room Activity Room Main Room AV Equipment needed?(Required)NoYesCheck specific equipment required: Vizio Television Laptop and cables Projector Large Projection Screen WI-FI (Available 24/7) Consent I agree to the terms.I have read, understand and agree to abide by the policy use of the Real County Public Library facilities. I further agree that I am personally responsible for the repair of damage to equipment or facilities and for the replacement of stolen equipment or furnishings that may occur during my group’s occupation of the RCPL space. Furthermore, I agree that RCPL will not be held liable for injuries to person or property that result from the activities described above.Signature (Responsible Party)(Required)Date(Required) MM slash DD slash YYYY
