Meeting or Event Purpose (be specific)*
Date of Meeting*
Beginning and Ending Times*
Number in Group (50 per room, 150 maximum)
Number of Rooms requested (1, 2 or 3)
Do you need the kitchen?
Number of 6'x30" Rectangle Tables Needed (seats 6-8 adults)
Number of 60" Round Tables Needed (seats 8-10 adults)
Number of Chairs Needed
Applicant making Request
City, State / Zip
The applicant, on behalf of the above organization, acknowledges that he or she has read and agrees to comply with the rules governing public use of the community room located at the Middlebury Community Public Library. The applicant accepts full responsibility for any damage to the Library's facilities or equipment during such use. The applicant further agrees to hold harmless, release and indemnify the Middlebury Community Public Library and the Town of Middlebury from any and all claims, losses, damages, or lawsuits for damages, arising in any way whatsoever from, allegedly arising from or related to the use of the Library's facility hereunder by the organization.