STAMP HERE
1 Olde Half Day Road, Lincolnshire, IL 60069
ROOM RESERVATION FORM
Community Room
(50-114 people)
Board Room
(max. 75 people)
Executive Conference Room
(max. 18 people)
COMMUNITY ROOM SETUP DESCRIPTION / ILLUSTRATION
Equipment requested (AV equipment unavailable)
Screen
Podium *AV equipment is not available
Room style (see room setup options below)
Style 1 Style 2 Style 3 Style 4
Other (include drawing in box below)
APPLICANT / ORGANIZATION INFORMATION
Requested date: Start time: End time:
Organization name:
Address:
Representative’s name: Email:
Address:
Phone: Number of persons expected:
I have received and read the Meeting Room Use Policy and I hereby certify the Organization detailed
above meets the criteria stated therein. I will furnish information to verify this upon request. I
understand any damage related to the event will be the responsibility of the Organization sponsoring
the event. I further certify I am an Officer of the Organization empowered to request the room and
accept responsibility on its behalf.
Signature: ____________________________________________________ Date: _______________
Name (print): ________________________________________ Title: _________________________
Approved By: Date / time submitted:
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