APPLICATION FOR USE OF WILTON LIBRARY FACILITIES

Wilton LibraryApplication for Use ofLibrary Facilities(For-Profit Organizationsand Private Events)Name of Sponsoring Organizationor Individual “Renter”) _____________________________________________________Street Address ________________City/State ______________ Zip Code _____________Telephone No. ____________Fax No. _____________Email ________________________Event Representative/Contact Person___________________________________________Street Address ________________City/State ______________ Zip Code _____________Telephone No. ____________Fax No. _____________Email ________________________Type of Event _____________________________________________________________(Example: Business Meeting, Holiday Reception, Anniversary Party, etc.) (“Event”)Date(s) of Event ___________________ Time of Event: From _____ To _____________Estimated Attendance _____________ Minors Present?* Yes ________ No __________Liquor Served? Yes _______No ______ Food Served? Yes ________ No __________Event Catered? Yes _______No _______By Whom? _____________________________Street Address ________________City/State ______________ Zip Code _____________Telephone No. ____________Fax No. _____________Email ________________________Designated “Alcohol Free” Person if alcohol will be served: __________________________Street Address ________________City/State ______________ Zip Code _____________Telephone No. ____________Fax No. _____________Email ________________________*See page 2 of Agreement for Use of Library Facilities for use by minors of LibraryFacilities requirements.Library Facilities Requested: (please check all that apply) All checked facilities shallconstitute the “Library Facilities”:All rental fees are calculated on an hourly basis. Partial hours are not prorated. Timerequired for set up and break down shall be included in the time charged.Hourly rates___ Brubeck Room with Courtyard*, Kitchen, and Lobby** $ 300___ Brubeck Room with Courtyard* and Kitchen $ 200___ Brubeck Room (includes Courtyard*) $ 150___ Lobby** with Courtyard* $ 100___ Crafts Room** $ 80___ Presidents’ Room, Rimer Room $ 50*Note that “unattended children are not allowed in the Library Courtyards” (page 3 ofAgreement for Use of Library Facilities).**Available only when Library is closed.

- 2 -There will be a Custodial fee for those rentals taking place before or after normalLibrary business hours or at any time on weekends as follows: A fee of $20 perhour before 10 am and from 8 pm-9:30 pm on Mondays-Thursdays and on Fridaysbefore 10 am and from 6 pm-9:30 pm; this fee is paid to the library. A fee of $30per hour after 9:30 pm on weekdays and at any time on weekends; this fee is paiddirectly to the Custodian.Room Set-Up: to be arranged with the Rentals Manager at least two weeks prior to theevent. In order to insure the best rental experience, any presentations must be emailed tothe Library (presentations@wiltonlibrary.org) no later than three business days prior to theRental. Any DVDs or CDs to be played at the Rental should be given to the Rentals Managerno later than three business days prior to the Rental.Equipment: (please check all that apply) All checked items shall constitute the“Equipment":TV/VCR/DVD combo ______________ Overhead Transparency Projector__________35 mm Slide Projector ____________ LCD Projector* ________________________Mic-Sound System* ______________ Stage Lights* _________________________Computer* _____________________ Piano** ______________________________DVD player* ____________________ iPod* ________________________________Other ____________________________________________________________________*In the Brubeck Room, this equipment will be operated by Library personnel only for a feeof $40 per hour paid to the Library for events taking place Monday–Friday duringregular business hours and directly to the Library Technician for events takingplace after regular business hours and on weekends. Computers and LCDProjectors in other Meeting Rooms will be set up by Library personnel. Renter isresponsible for turning off Computers and LCD Projectors in Meeting Rooms. If anLCD projector is not turned off by Renter, a $50 fee will be charged for bulbreplacement.**Use of a piano requires a piano use fee of $40. If Renter requires a piano to be tuned, atuning fee of $125 will apply.Rental Fees:All Fees are payable by Check, MasterCard or Visa.If Check, please make payable to: Wilton Library Association, Inc.Fee $_______per hour for _______hoursRefundable Security Deposit (if applicable)Piano Usage Fee: $40 (if applicable)Piano Tuning Fee: $125 (if applicable)Custodial Fee paid to Library: _______hours at $20 per hourCustodial Fee paid to Custodian: ______hours at $30 per hourTechnician Fee paid to Library: _______hours at $40 per hourTechnician Fee paid to Technician: _______hours at $40 per hourTotal Due$_________$_________$_________$_________$_________$_________$_________$_________$________Note: One half of Total Due is to be paid prior to the rental date and one half nolater than the rental date.

- 3 -Please complete this form and return with payment to:Wilton Library Association, Inc.137 Old Ridgefield RoadWilton, CT 06897-3000Attn: Rentals ManagerTel No. 203-762-3950, Ext. 247Fax No. 203-834-1166The Library shall reserve the Library Facilities for Renter upon the signed submission of thisApplication for Use, the execution of the Wilton Library Agreement for Use of LibraryFacilities by Renter and the Library and payment of the Security Deposit (if applicable).Renter Authorized Signature: _________________________________________________Date:__________________________________________________By:__________________________________________________Title:__________________________________________________Library Hours: Mon-Thurs: 10-8: Fri: 10-6; Sat: 10-5; Sun: 1-5 (Sept-June)

- 4 -FOR LIBRARY USE ONLYCertificate of Insurance Required Not Required Date ReceivedGeneral _______ __________ ____________Caterer _______ __________ ____________Liquor _______ __________ ____________Caterer License _______ __________ ____________Food Permit _______ __________ ____________Liquor Permit _______ __________ ____________No. Required Not Required Date of RequestPolice Officers _______ __________ ____________Fire Marshal _______ __________ ____________Chaperones _______ __________Agreement for Use is signed by Renter authorized signatory and Library Yes ________Agreement for Use is datedYes ________Application for Use is signed by Renter authorized signatoryYes ________Application for Use is datedYes ________Security Deposit received, if requiredYes_________