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2. Organization Name*
4. Contact Name*
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
15. First Choice Date/Time*
    First Choice Date/Time

    First Choice Date/Time
16. Second Choice Date/Time
    Second Choice Date/Time

    Second Choice Date/Time
18. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, 3) you have read and agree to the meeting room use policy, and 4) you may still be required to provide a traditional signature at a later date.

    1. I agree.
20. Electronic Signature*
21. Use Policy
    Use Policy

    Please read the meeting room use policy.
23. Instructions
    Please fill out the date and time on when you would like to use the community room. Please see scheduling restrictions outlined in the meeting room use policy. By signing the agreement, you fully understand and agree to the meeting room use policy. You will be contacted by our Executive Assistant to confirm availability.
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field