Request for Use of Public Meeting Space

Time requested?: *

:

am

pm

Which meeting room?: *

Bolton

Council Chambers

Rosemont Summit

Please select your meeting room.

Special Requests/Additional Information:

Please indicate any special requests or needs for your meeting.

Phone Number: *

Please enter the phone number of your organization or the phone number of the individual requesting the room.

Describe Room Use Activity: *

Please describe the activity or meeting purpose for which the room will be used.

Date requested?: *

Address: *

Please enter the address of your organization or the address of the individual requesting the room.

Email: *

Group Designee/Contact: *

Please enter the name of a person responsible in your organization for the room reservation.

Name of Organization: *

Please enter the name of your organization or the name of the individual requesting the room.

Is this a recurring request?: *

No

Yes - monthly

Yes - bi-monthly

Yes - quarterly

Please indicate if this request is for more than one date.

Hold Harmless Agreement: *

Agree

Disagree

I have read and understand the rules and policies as set forth by the City of West Linn regarding use of meeting rooms. I further attest that I will be personally responsible for repair of damage to equipment, the facilities, grounds or for replacement of stolen equipment while occupying the premises. It is understood and agreed that the City, its Mayor and Council, Board, employees, volunteers, and agents shall be held harmless against all claims, damages, loss or expenses, including attorney's fees, arising out of or resulting from the use of this facility.

Number of people expected to attend?: *

Please enter the number of people expected to attend.