North irwin town hall rental application

NORTH IRWIN TOWN HALL RENTAL APPLICATION

DATE__________________

NAME_________________________________________

ADDRESS______________________________________

PHONE#

HOME__________________CELL_____________________

N.I. RESIDENT____________________

DATE REQUESTED_______________________

REASON FOR REQUEST_______________________________

ARRIVAL/DEPARTING TIME_____________________________

# OF PEOPLE_____________

UNDERSTAND RULES/REGULATIONS____________________

SIGNATURE OF APPLICANT____________________________

ACCEPTED BY___________________________________

DATE______________________________________

COST $40 ($50 FOR NON-RESIDENTS) ___________

$50 CLEAN-UP DEPOSIT___________

PAID________________