Please call for room availability dates (715-536-7191) before mailing or faxing in this form.
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T. B. SCOTT FREE LIBRARY 106 W. First St., Merrill, WI 54452 Phone: 715-536-7191    Fax: 715-536-1705  
Date(s) requested: ________________________________________ Day(s) of week: _______________________

(Reservations will be accepted 3 months in advance.  Conditional reservations may be accepted further in advance with the understanding that rescheduling or canceling of conditional bookings is possible.)

Time of room use: From _____________________ to ____________________; Time meeting starts: ________

(Meeting must be concluded and all clean up completed before the library closes, unless prior arrangements are made. Arrangements for meeting room use before or after library hours must be made prior to the meeting day.)  

Room Requested (check one): ____ Board Room     ____ Community Room     ____ Story Hour Room (Register in the Youth Services Department.)   

Contact Information:  

Contact Person Name (Please Print): ____________________________________________________________
(Must be 18 years of age or older)     

Address: _____________________________________________________________ Phone :_______________

Alternate Contact Person: _____________________________________________________________________ 
(Must be 18 years of age or older)                                                              

Address: _____________________________________________________________ Phone:_______________  

Representing (organization): __________________________________________________________________  

This is a (check one):   ____ Non-profit organization             ____For-profit organization  

Meeting Information:  

Describe the nature of the meeting (continue on the back if necessary): _________________________________  

Approximate number of attendees: __________   Equipment needed: ________________________________  

Will light refreshments be served?       ____ Yes*    ____ No     *Note: You or your organization are responsible for providing food, cups, serving utensils, etc., as well as clean up.  Kitchen facilities are available for public use. A charge (minimum $25) may be assessed if premises are not left in satisfactory condition.  
Room Fees:
____ $10 per meeting (due only if your group has already used a meeting room twice in January through June, or July through December—otherwise free).  Room fees are due on the meeting date; organizations must be current on room fees to make future reservations.  Make check to T. B. Scott Library.  Send to: Bookkeeper, T. B. Scott Library, 106 W. First St., Merrill, WI 54452.

Agreement to Meeting Room Policy:  I have read the library's Meeting Room Policy and agree to follow the rules contained in the policy.

__________________________________________________________________________________________ (Signature)                                                                                                                (Date)  
RETURN OF THIS COMPLETED & SIGNED FORM TO THE LIBRARY RESERVES THE ROOM FOR YOUR ORGANIZATION.  You may deliver, mail, or fax (at 715-536-1705) this form to the library.