Community Room Request Form

Name of Organization

Type of Activity

Number of People

Date

Start Time

End Time

For repetitive events please add additional dates here:

Requests must be made at least 7 days in advance of the Trustee's meeting, typically held the last Tuesday of each month. Check the website (www.centralisliplibrary.org) for updates. It is understood that the undersigned will be personally responsible to see that all regulations of the Board of Trustees are observed and that the group or organization will be responsible for damage resulting from misuse of the facilities.

(Please remember to indicate preferred room set-up on form labeled COMMUNITY ROOM SETUP OPTIONS)

Person Responsible:

Office Held:

Address:

Phone:

Email:

Alternate Person to Contact:

Address:

Phone:

Email:

Central Islip Public Library

Community Room Request Form