KCTC Community Meeting RoomThrowing an event? We have you covered! KCTC Community Room Rental Agreement KCTC Community Room Rental Agreement PLEASE READ Rental Rate: First 4 hours for $60 and $10 for each additional hour, or 12 hours for $80.00 Chamber Member and Non-Profit Organization Discount = $15 1. Smoking and alcoholic beverages are prohibited. 2. Driveway east of building may not be blocked. 3. Space must be left in clean and orderly condition, floor vacuumed, tables wiped down, all equipment and furnishings returned to original placement. 4. Kitchen appliances and utensils must be used/cleaned/stored per posted instructions. Counters, sinks, appliances and floor must be left clean. Leave used dish towels/cloths on counter. 5. Garbage pickup is not provided. Renter is responsible for removing and properly disposing of all garbage/leftovers and replacing can liners with those provided. 6. Lock all doors and return hex keys to shelf. Make sure all lights and kitchen appliances are turned off. 7. Renter assumes all liability for any injury, loss or other damage related in any way to their occupation of premises. Renter understands they will be responsible for any damage to the facility or its furnishings. 8. Wi-Fi service is available (SSID is: KCTCMeetingRm-Guest). Renter agrees to use access only in compliance with KCTC Internet terms of service posted on KCTC website and will be responsible for any problems resulting from inappropriate use of connection. 9. Failure to comply with above in full may result in assessment of cleaning fee of $50. 10. Reservations not accepted without immediate full payment of rental fee. Cancellations more than 30 days prior to reservation are eligible for refund less $10.00 processing fee. Cancellations less than 30 days prior are not eligible for refund. 11. KCTC office hours are Monday-Friday, 8 a.m. – 5:30 p.m. If you have problems or questions, please call 656-3668 and leave a message and phone number for the on-call person or call 319-936-7506. 12. Your door pass-code PIN will be sent to you in an email. On your rental date and time this number will become active. Enter this number followed by # to unlock the east door. 13. Parking in the lot on east side of building is prohibited at all times. Park on the street (B Avenue) north of the building. Rental Date * Rental Start Time * 121234567891011 : 0030 AMPMRental End Time * 121234567891011 : 0030 AMPM Renter First & Last Name * Renter Phone Renter Cell Phone * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Renter Email * Date * Renter Signature * Clear By entering your full name in the box above, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.By checking the "I AGREE" box, you consent to receive the disclosure immediately below electronically. 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