Facility Use Application and Permit

FACILITY USE APPLICATION AND PERMIT
LAFAYETTE COUNTY, MISSISSIPPI

PURPOSE:

This application is to be completed by the individual or entity representative desiring to use any County facility for a particular date and time. Use permits will be issued through the County Administrator's office (236-2717) entitling the applicant to use such facility in a manner which will minimize the disruption of County operations and community activities and maximize equal access to such facilities by all citizens. By submitting this application, the designated individual or organization agrees to be legally responsible for any damage thereto and costs of cleanup.*

All fields marked with an asterisk (*) are required.


APPLICATION:

Business Name*

Contact Name*

Address*

Telephone Number*

Email*

Date of Meeting/Event*

Start Time and Duration*


County Facilites*: (Please Check One)

Square Courthouse
GroundsLarge CourtroomSmall Courtroom

Chancery Building
GroundsCourtroom #1Courtroom #2Courtroom #32nd Floor Board Room

County Extension Service
AuditoriumOther

Other


Explanation of Use*:


Non-Liability Agreement

By submitting this application, the undersigned agrees to be responsible for any material damage to the premises resulting from the undersigned's use of the designated facility. The undersigned also agrees to hold Lafayette County, its officials and employees harmless as to any claim arising out of the undersigned's use of the premises.

Signature*:

*Prior notice given at least 5 days in advance.
First come/first serve basis.