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Eau Claire District Library
Application to use Community Room
Please print or type this application
Date________________________
Individual
Name ____________________________________________________________________
Address ___________________________________________________________________
Phone ____________________________________________________________________
Purpose of function __________________________________________________________
Approximate number of people expected ___________________
Organization
Name of Organization ___________________________________________________
Name of individual filing the application ____________________________________
Address ____________________________________________________________________
Phone number _____________________________________
Position in organization _______________________________________________________
One time use
Date of function ______________________ Hours needed ____________________
(Example 7:00-8:30 PM)
Do you want to use the Kitchen? (Additional fee=$25.00) Yes No
Needed: Chairs _____________ Tables _____________
AV equipment __________ Other _____________
Repeat use
Dates of meeting ______________________________________________________________
(Example: 1st Monday, each month)
Hours needed _________________________________________________________________
Use requested from ____________________________ to ______________________________
(month, year) (month, year)
I have read the Eau Claire District Library Community Room Policy. I will be present at the meeting
described here and responsible for complying with those policies.
Signature ____________________________________________________________________
________________________To be filled out by Staff_______________________
Community room fee $25.00 Kitchen use fee $25.00 Deposit $25.00
Total amount received _______________
Fee received by _______________________________________________________________
Approved ____________________________ Date _____________________________
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MAKE CHECKS PAYABLE TO :
EAU CLAIRE DISTRICT LIBRARY
DROP OFF APPLICATION AT THE LIBRARY,
OR SEND TO:
EAU CLAIRE DISTRICT LIBRARY
6528 EAST MAIN STREET
P.O. BOX 328
EAU CLAIRE, MI 49111
PLEASE CALL 269-461-6241 TO CHECK FOR
DATES AVAILABLE.
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