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2. TOWN HALL FACILITIES USE

   Users of the meeting rooms in the Town Hall are limited to one (1) reservation per month.  The scheduling of reservations may occur no earlier than three (3) months in advance of the proposed use.  

   In the event the Town government is declared closed, the use of the Town Hall facilities is needed as an emergency shelter, or the Town Council is required to hold a special/emergency/continued meeting, any permission to use the facility is automatically withdrawn. 

6. Organization/Business' Name:*
8. Organization/Business' Mailing Address:*
10. Organization/Business' Physical Address*
12. Organization/Business' Phone Number:*
13. Organization/Business' Email Address:*
17. Organization/Business' Representative

    An organization/business who rents a meeting room in the Town Hall must identify an individual (must be at least 18 years of age) who will be present for the duration of the rental use and who will be personally responsible for the preservation of order; prior & post inspection of reserved area; conduct of those in attendance; safe use of the facilities; strict observance of Federal, State & Town laws; for reporting any injuries and/or property damage within 24-hours of use; and, for clean-up of the reserved room prior to departure.  The representative must have read the Town Hall Facility Use Policy prior to use of the facility and ensure adherence to the terms and conditions in the Policy at all times. 

19. Representative's Name:*
20. Representative's Phone Number:*
22. Representative's Email Address:*
23. Representative's Photo Identification*
27. Date of Proposed Meeting/Event/Activity*

    Mondays through Fridays, holiday excluded, only.

29. Starting Time of Proposed Meeting/Event/Activity:*

    Must include set-up time.  Starting time may not occur prior to 8:30 a.m.

30. Ending Time of Proposed Meeting/Event/Activity*

    Must include clean-up time.  Ending time must occur no later than 5:00 p.m.

32. Number of Persons in Attendance:*

    Number may not exceed the capacity of the Meeting Room

34. Nature of Proposed Meeting/Event/Activity*

    Please include a complete description so the proposed use can be evaluated to ensure it complies with the Town Hall Facility Use Policy.

36. Meeting Room Sought for Rental:*

    1. Executive Conference Room (maximum capacity 20 people)
    2. Council Chambers Audience Seating (excludes use of dais) (maximum capacity 46 people)
    3. Police Training Room (maximum capacity 12 people)

    The Town of Middleburg reserves the right to assign the applicant to a different room, once the application is approved, if the requested room is needed for Town government purposes.  Reservation of a meeting room does not restrict the use of the remainder of the facility or public areas by others. 

40. MISCELLANEOUS ITEMS ASSOCIATED WITH RENTAL
42. Use of Electronic and Audio-Visual Equipment

    Use of electronic and audio-visual equipment in the Council Chambers is restricted to Town government purposes only.  Only authorized & trained Town staff may use this equipment.  Such use is subject to prior approval of the Town Manager/designee.  

    Use of televisions/monitors in the Executive Conference Room or Police Training Room is permitted, subject to approval of the Town Manager/designee.  It is the responsibility of the user to coordinate/train on use of such equipment with the Town staff in advance of the meeting.  

    The connection of third-party equipment or devices to any Town system shall only be allowed with prior approval of the Town Manager/designee.  No  third-party power strips may be utilized in Town Hall facilities for any reason. 

44. Does your organization wish to use the television/monitors in the Executive Conference Room or Police Training Room?*

    1. Yes
    2. No
46. Does your organization wish to connect third-party equipment or devices to any Town system?*

    1. Yes
    2. No
48. Food & Beverages

    With the exception of water, food and beverages are not allowed in the Council Chambers.  Food and/or non-alcoholic beverages may be served/consumed in the Executive Conference Room or Police Training Room only if approval is granted by the Town Manager/designee in advance of the event.  

    A Cleaning/Damage fee of $250 must be paid at time of registration in the event anything other than water is served.  This fee will be refunded if the reservation is cancelled and the room is not used or if the room is left in a clean condition and no damage has occurred at the conclusion of the room's use.  

    The organization/business' representative will be responsible for ensuring no food and/or beverages are brought into and/or consumed in the room if prior approval has not been granted for its service. 

50. Does your organization/business plan to serve food and/or beverages?*

    1. Yes (If yes, the Cleaning/Damage Fee must be paid upon approval of your application)
    2. No
52. Signage

    A self-standing sign may be put in place one (1) hour before the scheduled start of the meeting/event/activity and must be removed at its conclusion.  A copy of the signage must accompany this application.

    Signs, emblems, banners, pennants, etc. may NOT be affixed to any Town Hall facility surface, to include but not limited to walls, light fixtures, and amenities located on Town grounds; or, to Town Grounds, including light poles, benches, etc. 

54. Does your organization/business plan to install a self-standing sign on Town Hall property?*

    1. Yes
    2. No
56. If yes, attach a photo of the self-standing sign
60. Electronic Submission of Application

    By submitting this application, I confirm that I (1) am an Authorized Agent of the organization/business identified in this application; (2) have read and agree to abide by the terms and conditions of the Town Hall Facility Use Policy; and (3) understand that the individual listed in this application as the Representative for my organization/business must sign an agreement confirming he/she/they has read and agrees to abide by the terms and conditions of the Town Hall Facility Use Policy.

62. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
64. Electronic Signature
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

* indicates a required field