Station form - Huntington Public Library

Room Application for Video Conference Usage at the Station Library

Room use limited to video conferencing for government, social services and employment needs. Not all requests can be accommodated.

Name

Date

Address

Phone Number

Email Address

Date and Time Requested

Reason for Usage

Do you need to use a library provided laptop?

Do you need other equipment?

If yes please specify what you will need.

Time Limit Agreement I understand there is a two hour time limit for the use of this room. By checking the box you agree to and understand the time limit.

Disclaimer and Signature I CERTIFY THAT: The meeting room will be used only for the stated activity. In addition, I certify that, I am authorized to accept and be responsible for compliance with all conditions pertaining to use of a Meeting Room including execution of a Hold Harmless provision.

Staff Name (if applicable)