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Roland Lewis Building Rental Agreement

Name of Contact Person

Phone Number

Email Address

Name of Applicant, Organization or Event

Address

Room Rental

Whole Building

South End

North End

Small Meeting Room

Start Time and End Time

Type of Meeting

Set-up Style

Classroom - Tables w/chairs on 1 side

Potluck - Tables w/chairs on both sides

Chairs Only

Number of expected attendance

Which direction to face?

Number of Head Tables

Number of Food Tables

I have read, understand and agree to abide by the Building Rental Policy of the City of Mt. Vernon facilities and equipment as stated within.

For Office Use Only

Date Received: Staff:

Total Fees Due: Setup Chart Received:

Fees Paid: Staff: Date: Balance Due: