Meeting Room

Newbury Town Library

Lois M. Anderson Community Room Request Form

(This form can be printed and mailed to the library. Please call the library or check the library calendar to confirm your requested date is available before mailing in the form.)

Date of Application: _______________________


Name of booking agent __________________________________________________________
Home address, street ______________________________________________________­­­­______
City/Town, State, Zip ____________________________________________________________
Telephone No. (day) ___________________ Telephone No. (evening)_____________________
Email Address: _________________________________________________________________
Organization represented _________________________________________________________
Nature of the Organization ________________________________________________________


Type of event:  _________________________________________________________________
Date needed:  ­­__________________________________________________________________­­­­
Start time (include set up):________________________________________________________
End time (include clean up):  ______________________________________________________

I certify that I have read and understood the Lois M. Anderson Community Room Policy and agree to abide by all rules & regulations governing the use of the facilities I am requesting to use:


Signature of Booking Agent: ________________________________________________________


You will receive an email notification as to the status of your booking request.



  • Approved: ___________________________________________
  • Donation received: __________________________________
  • Condition after use: ___________________________________
  • Repair or replacement costs for cleaning or damage to Library property. Total amount: ________________________