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2. Organization or Group Name:*
4. Address*
6. City
7. State
8. Zip
10. Organization Status*
    -- Select One --Government AgencyNon-Profit OrganizationOther
12. Contact Person*
14. E-mail Address*
15. Phone #*
17. Contact Person's Address*
19. Purpose for meeting room use*
21. Requesting Use of Kitchen?

    1. Yes
    2. No

    For Library Program Room only
23. Requested Date*
25. Requested Times*
27. The undersigned user of a meeting room has read the Safford City – Graham County Library Meeting Room Policy, understands and agrees to abide by the guidelines and rules described therein. Failure to abide by these rules may disqualify the organization from future use of the rooms. The user hereby indemnifies and holds harmless the City of Safford, its Library, employees, and volunteers from all liability directly or indirectly related to an event or meeting held at Safford City – Graham County Library under this application.
29. Consent*

    1. By checking this box and typing your name below, you agree to the above statement.
31. Signature*
    (Responsible party for user group)
33. Date Submitted*
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit Submit and Print

* indicates a required field