Library Use Request Form


All fields marked with * must be filled out. Incomplete forms will result in processing delays. Use the text box at the bottom of the page to elaborate on your needs. Press [Continue] to proceed to the next page. You may then review, print, sign, and mail the form with a check or money order to CUPF. Screen prints or unsigned forms will not be accepted. First-time users must also include a legible copy of the contact person's driver's license. If you wish to pay by credit card, you should establish a web-use account. Submitting requests on the web may expedite your response and allow you to pay for and print permits online.

Applicant's Name:*

Address*

City:*

State:* Zip:*

Organization Name:

Address:

City:

State: Zip:

Day Time Phone:*

Evening Phone:*

Email Address:*



Preferred Location : * (Please select one or more )
   1st choice *
   2nd choice
   3rd choice
Nature of Meeting: *
Room Requested: *
(If no preference, enter 'any')
Large Room     Small Room
  Piano (Bethesda, Chevy Chase, Gaithersburg, Marilyn J Praisner, Rockville and Twinbrook only; with an additional $25 payable to the library per recital for piano use)
# Participants: *
Fee Charged to Participants *? Yes No
Start Date: * (mm/dd/yy)
End Date: * (mm/dd/yy)
Meeting Time: * (e.g., 7-8pm)

If you require more than 1 date, please list all dates below. You may also specify day of week preference (e.g., every Tuesday).
Additional Remarks to Scheduler: