Form must be filled out completely

Organization Name:

The organization is: (check only one)

City or other Government Agency

Non–Profit Group

For–Profit Group

Your Name:

Position with organization:

Mailing Address:

Email Address:

Phone Number:

Purpose of Meeting:

Requested Meeting Date (include day of the week and date):

Advertised Meeting Time:

Requested Reservation Time (include set up and clean up):
From to

Estimated attendance:

Advertised Contact Information: Name and Phone Number:

This information will be given out by Library staff to patrons requesting more information about your event.

Requested number of long tables:

Requested number of chairs:

Chairs and tables will be set up in rows facing the front of the room unless you indicate special set up here:

Additional equipment requested: (Please check all that apply)

Microphone

Surround Sound System

TV

VCR/DVD Player

CD Player

Podium

Screen

Projector

Library Laptop

I will be bringing a personal device to connect to the TV or projector.

If you are bringing your personal device, please call the library at least 1 day before the approved meeting time to ensure it will connect to the TV or projector.

By submitting this form, I affirm that I have read, understand and agree to the terms of the Meeting Room Policy, including the Waiver of Liability. I understand that my request is not approved until I get a reply from Jacksonville Public Library staff.