Meeting Room Form - Upper Providence Township
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1Upper Providence Township
935 N. Providence Road
Media, PA
610-565-4944
Meeting Room Request Form
The Municipal Building is a publicly owned accessible building with two meeting rooms that are
available for use of the Township residents and non-profit, non-political groups. The rental fee is
$50 and includes the use of a meeting room, rest rooms, and parking facilities.
One of the Township constables will be notified of your meeting date and time and will open and
close the building accordingly. The facilities will be inspected prior to your occupancy and after
your departure. Any damages occurring during your rental will be the responsibility of your
group and you will be invoiced for any needed cleaning or repairs.
Date of Use _______________ Start time_______________ End time: ______________
Name of individual/group requesting use of facilities _____________________________
Please check room requested.
Council Room – (council table and seating for approximately 40.) ______
Conference Room – (oval table and seating for approximately 8.) ______
Number of individuals expected ________________.
Contact person for group:________________________________________
Phone number of contact person/group:_____________________________
Address of contact person/group: __________________________________
By signing below you are accepting responsibility for the use of a meeting room.
Signature of individual/contact persons:________________________________________
****************For office use only*****************
Date Requested _____________ Fee Paid______________ Check #_____________
Room use confirmed by____________on _________________
Use written in calendar book _________ Constable notified of request __________
****************For Constable Use only****************
Start time_______ Pre-inspection________End time______ Post-inspection______
Date____________________ Constable’s Signature ______________________
– $30 fee will be charged if the township is not notified 24 hours in advance
*Cancellation Fee
of cancellation.
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