PRINT OUT, FILL IN AND RETURN TO APPROPRIATE LIBRARY LOCATION
OR FAX to 413-263-6825


   SPRINGFIELD LIBRARY  SYSTEM 
220 State Street, Springfield, MA 01103  Phone: 413-263-6828 x422   Fax: 413-263-6825


APPLICATION FOR MEETING ROOM USE

Please FILL IN AND RETURN:
FAX to (413) 263-6825 or Email: jstupak@springfieldlibrary.org

Application may be faxed or emailed, and must be approved before a meeting can be confirmed.

Desired Location:

Central Library _________ Forest Park Branch __________
Brightwood Branch _____ Sixteen Acres Branch _________
Mason Square ________   Other (please indicate branch): _____________

Application Date: ___________________ Program Date: ____________________
Time needed (include time for set-up and clean-up): _______________________
Publicized Starting Time of the Program: __________________________________
Name of Organization/Group: _________________________________________________
Meeting Purpose or Function: ________________________________________________
Title of Program: ___________________________________________________________
Principal Speaker: __________________________________________________________
Expected # Attendance: ____________________________________________________
I HAVE READ THE POLICY AND RULES OF THE LIBRARY FOR MEETING ROOM USE AND AGREE TO COMPLY.

Applicant's Name (please print): __________________________________________
Applicant's Signature: __________________________________________________
Address: _____________________________________________________________
Telephone Number: ____________________________________________________
E-Mail Address: _______________________________________________________

If the public requests information, we will refer them to you.

For additional information, call the Community Relations Coordinator at (413) 263-6828, x422

FOR LIBRARY USE ONLY:

Confirmation Date: ___________________
Print Material Approval:________________
Additional Information:

Return to Meeting Room Policy page.