Instructions: Please print and complete all information requested and return to West Branch City Hall at the above address.
ALL RESERVATIONS ARE SUBJECT TO THE RESERVATION POLICY CONCERNING PAVILION USAGE IN IRONS PARK. PLEASE REVIEW THE POLICY BEFORE PROCEEDING FURTHER.
To be completed by Applicant:
Name: ___________________________________ (H) Phone: ____________________________
Address: _________________________________ (W) Phone:
____________________________
_________________________________
Check Facility Desired:
[ ] Large Pavilion
[ ] Small Pavilion
[ ] Gazebo
Desired Date: ______ /______ /_________ From ___:___(AM/PM) To ___:___(AM/PM)
Alternate Date: ______ /______ /_________ From ___:___(AM/PM) To ___:___(AM/PM)
Number in Party: __________ Type of Occasion / Event: ______________________________
Amount Enclosed $: ________________ (Make checks payable to the
City of West Branch)
Agreement: I have received, read and agree to abide by all park ordinances, rules and
regulations, as well as all conditions on this application.
Applicant Signature: _____________________________ Date: ______ /______ /__________
For Department Use Only
_____Key for gate checked out _____Key for gate returned