SEMINOLE COMMUNITY LIBRARY AT ST. PETERSBURG COLLEGE 9200 -­‐ 113th STREET, SEMINOLE, FLORIDA 33772 727-­‐394-­‐6905 • www.spcollege.edu/scl • scl@myseminole.com PROGRAM ROOM RESERVATION FORM
This form can be filled out, printed and mailed to the address above or
submitted electronically by filling it out online and emailing it to
Marion Chamberlain at mchamberlain@myseminole.com
Contact Information and Description of Use
Today’s date: ___________________
Name of organization: _______________________________________________________________
____ Non-profit Organization
____ For-profit Organization
____ Governmental Agency
Name of organizational representative: __________________________________________________
Address of organization or representative:
____________________________________________________________________________________
City: ________________________________________________ State: __________ Zip: ___________
Telephone: ______________________ E-mail address: ______________________________________
Room(s) requested: ____ Program Room A
____ Program Room B
____ Program Room C
Day and Date requested: _______________________________________________________________
Day of week
Date
If multiple dates are requested, please indicate: _____________________________________________
Starting time of activity: _______________
Total time requested (including set-up and break-down): From ______________ To _______________
Description of how room will be used: ____________________________________________________
Will food or beverages be served?
______ Yes
______ No
Room set-up and break-down is the responsibility of the organization using the room (not library staff).
Please indicate the number of chairs and tables needed: _____ Chairs
_____ Tables
Technology and Equipment Needs
Equipment
Cost (per half day unless noted)
____ Betacam
100.00
____ Betacam SP Player/Recorder
20.00
____ Conference Telephone
40.00 + per minute (long distance)
____ DVD/VHS Player Recorder
40.00
____ Easel
10.00
____ Flipchart Pad - Purchase (includes use of easel)
40.00
____ Folding Chairs (addition to standard)
2.00 each
____ Folding Tables – each
10.00
____ IP Address Phone
20.00
____ Laptop Computer
40.00
____ Markers - Purchase
10.00
____ Microphone (fixed) with Podium
40.00
____ Organ*
500.00/event
____ Overhead Projector
20.00
____ Piano – Steinway*
500.00/event
____ Piano -- Upright*
200.00
____ Plasma Screen Package (includes laptop)
200.00
____ Podium only
10.00
____ Projector Screen (portable)
10.00
____ Risers
150.00/event
____ Slide Projector
20.00
____ Stage (small)
30.00
____ Streaming (includes Tech)
1,000.00
____ TV/VCR
20.00
____ VHS Camcorder
40.00
____ Video/LCD Projector (portable)
60.00
____ Video/LCD Projector (ceiling mounted with screen)
100.00
____ Whiteboard - large on wheels
10.00
____ Whiteboard - small
6.00
____ Wireless Microphone System
40.00
* Requires prior approval through the SP/G Music Department.
Special support services (technical, security, maintenance) are available at a negotiated fee from St.
Petersburg College. Please indicate any special support services needed:
Costs
(Library Staff Use Only)
Deposit (refundable – pending):
Room Rental (non-refundable):
Room Rental Tax (non-refundable):
Technology/Equipment Rental (non-refundable):
Technology/Equipment Rental Tax (non-refundable):
Liability Insurance (non-refundable):
Special Support Services (non-refundable):
$ ________________
$ ________________
$ ________________
$ ________________
$ ________________
$ ________________
$ ________________
TOTAL:
$________________
Please make check payable to ST. PETERSBURG COLLEGE and deliver to:
Program Rooms
Seminole Community Library at SPC
9200 – 113th Street
Seminole, FL 33772
Affirmation
On behalf of my organization:
1. I understand and accept all conditions and terms of use set forth in the PROGRAM ROOM
POLICY and this PROGRAM ROOM RESERVATION FORM.
2. I understand and accept that a room or rooms will not be reserved and placed on the room
reservation calendar until this signed, completed PROGRAM ROOM RESERVATION FORM
is returned to the library director or designee.
3. I understand and accept that a check payable to ST. PETERSBURG COLLEGE for any
applicable costs must be paid on or before the day of my reservation.
4. I understand and accept that I must supply proof of liability insurance as described in the
PROGRAM ROOM POLICY, if applicable.
5. I understand and accept: (1) that other activities may be scheduled in adjoining Program Rooms at
the time of my reservation; (2) that the movable walls separating the Program Rooms are not
absolutely soundproof; and (3) that City-sponsored or College-sponsored activities have priority
over all other activities in the program rooms.
Signature of Organizational Representative
Library Director or Designee: _____ Approved
Signature of Library Director or Designee
Deposit: $________
Damage Assessment: $________
Date
_____ Denied
Date
Balance due applicant: $________
2015/02/03