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<br />City of San Leandro <br />Library Services Department <br />300 Estudillo Ave. <br />(510) 577-3968 <br />Contact Information (510) 577-3967 FAX <br /> Organization: __________________________________________________________________________________ <br /> Contact Person: ________________________________________________________________________________ <br /> Home Address: ________________________________________________________________________________ <br /> Street City Zip Code <br /> Phone: (_____)_____________ Work Phone: (_____)____________ Email: _______________________ <br />Meeting Information <br /> Type of Activity: _________________________________________________________________________________ <br /> Day & Date: _______________________________________ Estimated Attendance: _________________________ <br /> Time needed (set-up thru clean-up): ______ am pm to ______ am pm Event starts at: ________ am pm <br />Facility Information <br />____ Mary Brown Room ____ Conference Room B ____ Estudillo Room <br />____ Trustees Room ____ Conference Room C ____ Dave Karp Senior Facility <br />____ Lecture Hall ____ Manor Branch Program ____ Kitchen <br />Room Arrangement (check one) Number of Chairs: _________ Number of Tables: _________ <br />____ Auditorium Style (rows of chairs) ____ Banquet Style _____ Food or Beverage Table <br />____Conference Table Style ____ Classroom Desk Style ____ Registration Table <br />Equipment – Equipment rental prices listed in the Facility Usage Fees and Guidelines <br />____ Projector, Movie ____ Mic, Hand held ____Flip Chart w/o paper ____ TV/VCR <br />____ Projector, Overhead ____ Mic, Standing ____Flip Chart with paper & pens ____ TV/DVD <br />____ Projector, Slide ____ Mic, Table Top ____Wooden easel ____Screen <br />____ Projector, Power Point ____ Mic, Podium ____ Dry Erase Board with pens <br />____ Conference Phone ____Mic, Lapel ____ Portable podium <br /> <br />Reservation Agreement: <br />If Application is granted, I agree to comply strictly with the facility guidelines, to supervise care in use of all facilities and <br />equipment, and make good any damage or loss of property arising from our occupancy of any portion of the building. <br />ALL PARKING LOT RESTRICTIONS APPLY TO MEETING ROOM USERS – TWO HOUR LIMIT. <br />Please Note: All applications are tentative until permit is issued. <br /> <br />________________________________________ _________________________________ <br /> Applicant’s Signature Date <br />For Library Use Only <br />Facility Fee ______________ User Eligibility: <br />Security Fee ______________ Group A ____ Group E ____ <br />Insurance ______________ Group B ____ Group F ____ <br />Equipment Rental ______________ Group C ____ Group G ____ <br />Damage Deposit ______________ Group D ____ <br />Maintenance ______________ <br />Total Due: $ ____________ Room Assignment: __________________________________ <br /> <br /> Approved by: ________________________________ Date: __________________________ <br />Single Event Meeting <br />Room Application