Library Conference Room Rental Application Name of Renter / Responsible Party* Telephone Number*Email* Name of Company / Organization Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Driver's License / ID Number* Rental Date* MM slash DD slash YYYY Rental Time* : Hours Minutes AM PM AM/PM Nature of activity for which the facility is being rented:Are children included in this event? Yes No Estimated Attendance: Will admission be charges? Yes No Rates / FeesRate is $10 / hr, please indicate requested number of hours*I agree to abide by the laws of the State of Florida and to abide by the rules and regulations governing the use of a City of Mulberry facility.* I agree CAPTCHA Δ
