Meeting Room Use Form - Port of Benton

Meeting Room
Use Form

Meeting Room Use Form

Public Meeting Room Application

Name of Group/Organization: *

Mailing Address: *

Mailing Address:

Street Address

Bldg, Suite, etc. (if applicable)

City

State/Province

Zip/Postal

State of Washington UBI #

Contact Information

Contact Name: *

Email Address: *

Business/Home Phone: *

Cell Phone: *

Scheduling Information

Date Requested: *

Room Requested *

Start Time: *

End Time: *

Anticipated Number in Attendance: *

Is this a recurring event? *

Yes

No

End date of recurring meeting: *

How frequently does the event reoccur?

Weekly

Monthly

Secondary Details

Will food be served? *

Yes

No

Do you have Audio/Video needs? *

Yes

No

Additional Details:

Use this space to add any additional information necessary to describe your meeting or event you feel will assist the Port in determining space needs and/or eligibility of use.

I have read and understand the Port of Benton's Room Use Policies. I further understand that (please check both boxes below):

Damage Fee Acknowledgement: *

I am responsible for any damage incurred. A damage fee may be charged for actual replacement or repair fees.

Cleaning Fee Acknowledgement: *

A cleaning fee may be billed at the rate of $30 per hour, if meeting space is not left in order.

Authorized Signature: *

Clear

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