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2. First Name*
3. Last Name*
5. Organization Name
7. Do you need the meeting room for a nonprofit or private meeting?*
   -- Select One --NonprofitPrivateOther
9. Description of Program
11. Description of Program
13. Number of expected attendees

    Maximum occupancy of the Meeting Room is 65 persons.

15. Email*
16. Phone
18. Address
22. City
23. State
24. Zip
26. A valid Polk County Library Cooperative card is required to reserve the meeting room, please enter your card number below.*

28. If you do not have a Polk County Library Cooperative card, please visit a Polk County Library [or this link] to obtain one before reserving.”

30. Date Requesting*
    Date Requesting
31. Time Length*
    Time Length Start Time

    —

    Time Length End Time
    Please tell us what time you actually need to start setting up for your meeting. For example, if you need 30 minutes to set up and your meeting begins at noon, please put down 11:30 a.m. as your start time.
33. Is this a recurring program?

    Reservations can be made for up to three (3) months in advance.

35. Weekly

    1. once per week
37. Monthly

    1. 1st week of month
    2. 2nd
    3. 3rd
    4. 4th
38. Days of week
    -- Select One --MondayTuesdayWednesdayThursdayFridaySaturday
40. Irregular

    1. other
41. Enter additional/irregular dates
43. Please upload proof of non-profit status, if applicable.
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field