Updated 7/17/13
APPLICATION FOR ORGANIZATIONAL USE OF BOONE COUNTY CONFERENCE ROOMS
The undersigned organization hereby applies for a use permit to use Boone County Government conference rooms as follows:
Organization:
Address:
City: State: ZIP Code
Phone: Website:
Individual Requesting Use: Position in Organization:
Facility requested: Chambers Room 301 Room 311 Room 332 Centralia Clinic
Event:
Description of Use (ex. Speaker, meeting, reception):
Date(s) of Use:
Start Time of Setup: AM/PM Start Time of Event: AM/PM
End Time of Event: AM/PM End Time of Cleanup: AM/PM
The undersigned organization agrees to abide by the following terms and conditions in the event this application is approved:
1. To abide by all applicable laws, ordinances and county policies in using Boone County Government conference rooms.
2. To remove all trash or other debris that may be deposited (by participants) in rooms by the organizational use.
3. To repair, replace, or pay for the repair or replacement of damaged property including carpet and furnishings in rooms.
4. To conduct its use in such a manner as to not unreasonably interfere with Boone County Government building functions.
5. To indemnify and hold the County of Boone, its officers, agents and employees, harmless from any and all claims, demands,
damages, actions, causes of action or suits of any kind or nature including costs, litigation expenses, attorney fees, judgments,
settlements on account of bodily injury or property damage incurred by anyone participating in or attending the
organizational use of rooms as specified in this application.
Organization Representative/Title:
Phone Number: Date of Application:
Email Address:
Applications may be submitted in person or by mail to the Boone County Commission, 801 E. Walnut, Room 333, Columbia,
MO 65201 or by email to commission@boonecountymo.org.
PERMIT FOR ORGANIZATIONAL USE OF BOONE COUNTY GOVERNMENT CONFERENCE ROOMS
The County of Boone hereby grants the above application for permit in accordance with the terms and conditions above written. The
above permit is subject to termination for any reason by duly entered order of the Boone County Commission.
ATTEST: BOONE COUNTY, MISSOURI
County Clerk County Commissioner
DATE:
