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City of Lafayette


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Senior Room Rental Form

DO NOT CONSIDER THIS ROOM RESERVED UNTIL FORMAL CONFIRMATION IS RECEIVED.

Staff will follow up with confirmation, fees and damage deposit.

 
* Today's Date: 
* Date Needed: 
* Time (Start time) 
* Time (End time) 
* Equipment Needed 
* Group Name: 
* Address: 
* City: 
* State: 
* Zip: 
* Contact Person: 
* Phone: 
* Office: 
* E-mail: 
* Fax: 
* Expected Attendance: 
* Purpose of Rental: 
* Name of Applicant: 
* Date submitted: 
 

I have read the foregoing policies and fully agree and accept all responsibility for the terms and conditions of this agreement.

 
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