Print this page, complete the form, then bring to Clark Memorial Library to request your reservation of the Community Room.
Name: ________________________________________________________________ Date: _______________________________
Organization: __________________________________________________________ Title: _______________________________
Email: ________________________________________________________________ Phone: ______________________________
Address: ___________________________________________________________________________________________________
___________________________________________________________________________________________________________
No. of Attendees: _________________________
No. of Tables: _____________________________
No. of Chairs: _____________________________
Equipment Needed: __________________________________________________________________________________________
Reason: _____________________________________________________________________________________________________
Days Needed: Mon___ Tues___ Wed___ Thurs___ Fri___ Sat___
Frequency Needed: One time___ Every Week___ Every Other Week___ Every Month___
Event Start Time: ________________________ End Time: _____________________________
First Date Needed: ______________________ Last Date Needed: ______________________
Other: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Date Room Requested: _______________________________
Date Room Approved: ________________________________ By: _____________________________________ Title: __________________________________
** Bring this completed form to Clark Memorial Library, 538 Amity Road, Bethany, CT to request your reservation of the Community Room. **