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Display Space Application

 

Are you applying on behalf of (Please check one.)

___  a non-profit or community-based organization

___  a business or business organization

___  an individual or individuals

 

Name of the Applicant: _________________________________________________

Address: ____________________________________________________________

City, State & Zip: ______________________________________________________

Applicant’s Telephone: _______________________________

Applicant’s Email Address: ____________________________

Name of the Contact Person for the Business or Organization: ____________________________

Contact’s Telephone: _______________________________

Contact’s Email Address: ____________________________

When would you like to use the display case or space? (Please specify a month and year.)

(First Choice) Month : ________________ Year: ____________

(Second Choice) Month : ________________ Year: ____________

Are you a Seekonk resident or does your organization serve people in Seekonk?

___  Yes

___  No

Have you used the library display case or space in the past two years?

___  Yes

___  No

Have you received, read and understood the Library’s Policy on use of the display case and policy?

___  Yes

___  No

_______________________________________________________ _______________

Signature of Applicant or Representative Date

Please briefly describe what you wish to put on display and your purpose for doing so. Please feel free to attach photographs, printed materials or list your website. Please also note any awards or prizes that you or your organization may have received.

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The library display case and space is made available as a public service. How will your display complement the mission of the Seekonk Public Library? Please briefly describe how this display will inform, inspire or entertain the people of Seekonk.

____________________________________________________________________________

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The application was received on __________________ by ____________.

Approved by the Director __________________________________ on _____________

Signature Date