2. Dartmouth Public Libraries

   
   Southworth: 508-999-0726, x4103
   North Branch: 508-999-0728

   MEETING ROOM USE APPLICATION 

4. Name of Organization:*
6. Contact Person for Event:*
8. Mailing Address:*
10. Phone #:*
11. Email:*
13. Please select the branch:*
    -- Select One --SouthworthNorth Branch
15. Southworth Meeting Rooms:*
    -- Select One --Elsie Haskell AuditoriumSouthworth Meeting Room
16. North Branch Meeting Rooms:*
    -- Select One --Suzanne E. McDonald Community RoomNorth Branch Small Meeting RoomNorth Branch Children's Craft Room
18. Date of Event:*
    Date of Event:
19. Time of event:*
    Time of event: Start Time

    —

    Time of event: End Time

    Please include set-up and clean-up time.

21. Purpose of Event*
22. Anticipated attendance:*
24. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
26. Electronic Signature
27. Date:*
    Date:

    Date:
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field