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					                                CITY OF WORCESTER
                            DEPARTMENT OF PUBLIC WORKS AND PARKS
    Parks, Recreation and Cemetery Division 50 Skyline Drive Worcester, MA 01605-2898
 Robert L. Moylan, Jr., P.E.                                          Robert C. Antonelli, Jr., CPRP
 Commissioner                                                         Assistant Commissioner

                                                                      (508) 799-1190
                                                                      (508) 799-1293 FAX
                                   Michael V. O’Brien, City Manager

                APPLICATION FOR MEETING ROOMS AT SKYLINE DRIVE

NAME________________________________ADDRESS__________________________________

CITY______________________________________ STATE ____________ ZIP_________________

ORGANIZATION________________________________________ PHONE___________________

REQUESTING USE OF MEETING ROOM A____                 B____ C _____ D ______

PURPOSE _________________________________________________________________________

DATE__________________________________ TIME ______________ M. TO _____________ M.

ESTIMATE NUMBER TO ATTEND _______________

HAVE YOU EVER HAD A SIMILAR PERMIT? ___________YES ____________ NO

SPECIAL REQUEST OR SERVICES REQUIRED BY MAINTENANCE STAFF: _________________
_____________________________________________________________________________________

ANY SPECIAL REQUESTS REQUIRING PARKS STAFF SERVICES WILL BE AT A CHARGE OF
45.00/HR WITH A MINIMUM OF FOUR (4) HOURS (This fee is subject to change).

PARKING IS NOT ALLOWED AT THE NATIONAL GUARD BUILDING PARKING LOT
DURING BUSINESS HOURS

PERMITTEE WILL BE RESPONSIBLE TO ASSIGN A PERSON TO DIRECT ALL MEETING
ATTENDEES TO PARK THEIR VEHICLES AT THE PARKING LOT BETWEEN THE
ATHLETIC FACILITIES AND THE HANDBALL COURTS (ACROSS FROM WORC
TECHNICAL HIGH SCHOOL). NO EXCEPTIONS


APPLICANTS SIGNATURE: ____________________________________ DATE: _________________




                                             Print Form




      “Serving Our Community”                                               “Pride In Our Parks”

				
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