VILLAGE OF ROCKVILLE CENTRE
P.O. BOX 950
ROCKVILLE CENTRE, N.Y. 11571-0950
Date:____________________
TO: Lois Tinghitella 516-678-9225 Fax
Administration 516-678-9264 Phone
FROM: ___Request for use of Railroad Marquee
___Request for use of Village Channel 18
Wording to appear on Railroad Marquee or Village Cable Channel 18
Name of Event:______________________________________________________________________________
Date:______________________________________________________________________________________
Time:______________________________________________________________________________________
Place:______________________________________________________________________________________
For Info. Call________________________________________________________________________________
Name of Organization________________________________________________________________________
Requested by_______________________________________________________________________________
Address____________________________________________________________________________________
Daytime Telephone No:_______________________________________________________________________
Kathleen MacDonald Murray
Village Administrator
Revised 11/22/16
FOR OFFICE USE ONLY
Date:______________
cc: MIS Dept.
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