Facility Meeting Room Use – Lacey Fire District 3

Today's date *

Name of Agency/Organization *

Applicant/ Representative Name *

First

Last

Email *

Phone *

Alternate Representative Name *

This person authorized to change meeting date, location and/or time

Alternate's Email *

Alternate's Phone *

Describe the purpose of your organization *

Meeting room requested *

Station 31 - 1231 Franz St SE
Station 33 - 6500 Mullen Rd SE
Station 34 - 8447 Steilacoom Rd SE
Station 35 - 3701 Willamette Dr NE

Occupany maximum per station: Station 31=40, Stations 33 & 35 = 15, Station 34 = 20

Number of people attending *

More than 40 exceed meeting room capacity.

Date of meeting *

If requesting more than one meeting date, use this space for the first meeting date, and use the box below for additional meeting date requests.

Additional Meeting Dates

Please specify additional dates in this format: Day of week, Month, Day, Year (e.g. Friday, January 1, 2021)

Meeting start time *

Meeting end time *

Is this an annual HOA meeting? *

yes
no

The applicant and/or organization agrees to indemnify and hold harmless the District against all loss, damage, expense and penalty arising from any actions or claim on account of any injury to person or property of any kind whatsoever, which may be occasioned by the use of the facility during the period set forth herein or while the facility is in use by the above name organization, agency or person: *

I hereby agree

I understand the access key must be picked up during regular business hours and returned with 24 hours of use *

I hereby agree

The agency, person or organization agrees to return the facility to the condition found at the time of use and to notify the District of any damage that occurs during use *

I hereby agree

The agency, person or organization agrees to repair or replace where necessary any damage that occurs to the facility while in use *

I hereby agree

Meeting rooms are equipped with tables and chairs. The District does not supply any audio/visual and other technology equipment. a projection screen and electrical outlets are available for use with your own equipment. *

I hereby agree

District facilities are smoke free. use of alcoholic beverages and/or controlled substances is strictly forbidden. *

I hereby agree

Food and/or beverage serving must be approved in advance *

I hereby agree

I understand that entryway doors should not be propped open during use. *

I hereby agree

As an authorized representative of the requesting organization, I agree to the terms of use of Lacey Fire District 3 facilities, and that failure to do so may result in the denial of future use. *

Your signature here

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