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Meeting Room Request Form

  1. Will you be the person checking in for the meeting?*
  2. Do you have a Kearney Public Library card?
  3. Does the check-in representative have a Kearney Public Library card?
  4. Is there another check-in representative?*
  5. Are you a non-profit organization?*
  6. Please include set-up and tear-down time in your request.
  7. Would you like to request multiple meeting dates?
  8. Available amenities:*
  9. Items you will provide:*
  10. Policy Agreement*
    As an authorized adult representative of the above organization, by selecting "agree," I hereby apply for the use of the meeting room as indicated above. I have read the policies and rules governing the use of the meeting room facilities and agree that they will be carefully observed. If a meeting is canceled, I agree to notify the library as far in advance as possible.
  11. Please Note: A confirmation email will be sent once the meeting is approved.
  13. Application Approved by:
  14. Date Approved:
  15. Assigned Room:
    Loup / North Platte / South Platte / Niobrara
  16. Contact Signature:
  17. Deposit Paid
    Cash Check
  18. Deposit Returned
    Yes / No / Donated
  19. Contact Initials
  20. Library Staff Initials
  21. Leave This Blank:

  22. This field is not part of the form submission.