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Book the Program Room
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Book the Program Room
Program Room Application
Permission is hereby requested for use of the Program Room and other equipment as noted below. The person signing this application has read
The Woburn Public Library's Program Room Policy
and pledges the cooperation of the community group, organization, or business they represent. The signer assumes personal responsibility for discipline and reasonable care of the meeting room and equipment and furnishings therein during the use of the room. The Woburn Public Library Board of Trustees, the Library, and/or the City of Woburn will not be responsible for injury of persons or property while the building and grounds are used by any non-library entity.
APPLICANT INFORMATION
Name of Applicant:
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email Address
(Required)
Phone Number
(Required)
GROUP/ORGANIZATION INFORMATION
Name of Community Group, Organization, or Business:
(Required)
Please select one:
Please Select One of the Following:
(Required)
This is a business. Please email
[email protected]
or attach to this form a certificate of insurance affording the following coverages: General Liability of at least $1,000,000 Occurrence/$2,000,000 General Aggregate. The City should be named as an Additional Insured.
This is a community group or non-profit organization. Please email or attach to this form a copy of the organization’s 501(c)(3) determination letter to
[email protected]
. Applications from non-profit entities will be considered incomplete until receipt of the 501(c)(3) determination letter.
Is this community group, organization, or business based in Woburn?
Yes
No
I acknowledge a fee will be assessed if my community group or organization is based outside of Woburn or if I am representing a for-profit business based in or outside of Woburn. All fees must be paid in advance by check to the Woburn Public Library, once the applicant receives email approval for the scheduled Program Room use.
(Required)
I acknowledge a fee will be assessed if my community group or organization is based outside of Woburn or if I am representing a for-profit business based in or outside of Woburn. All fees must be paid in advance by check to the Woburn Public Library, once the applicant receives email approval for the scheduled Program Room use.
I Agree
Optional: Upload certificate of insurance or 501(c)(3) determination letter here:
Drop files here or
Select files
Max. file size: 300 MB.
REQUEST INFORMATION
60 seat Program Room - $100/hour, including set-up and break-down.
Date of Meeting:
(Required)
MM slash DD slash YYYY
Start Time of Meeting:
(Required)
Hours
:
Minutes
AM
PM
AM/PM
End Time of Meeting:
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Number of Expected Attendees:
(Required)
Please enter a number less than or equal to
60
.
Purpose for which Program Room use is requested:
(Required)
Equipment Requested for Program Room (must be requested at time of application):
Ceiling-Mounted Projector
Sound System
Blu-Ray Player
Drop-Down Screen
Assisted Listening System
Portable Whiteboard
Room Setup Details:
Do you need tables and chairs? Do you need a specific layout? Please let us know. If this section is not completed, it will be up to the applicant to setup the room during their requested time period.
Signature of Applicant:
(Required)
Program Room Policy
(Required)
I have read and agree to the
Program Room Policy
.
Δ