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City of Gem Lake Office Use Only Heritage Hall Date Issued: 4200 Otter Lake Road I Gem Lake, MN 55110 Base Fee: See Below ( 651-747-2790/92 1 651-747-2795 (fax) (Payable to City of Gem lake) E-mail city@pemlakemn.org Receipt No. Heritage Hall Rental Reservation First Come, First Served Basis APPLICATION CHECKLIST: To prevent delay, please ensure the following information is submitted ❑ Application ❑ Application Fee for Residents (if paying with cash we can only accept exact change) ❑ Large Conference Room (Monday -Thursday Evenings) ❑ Small Conference Room (Monday -Thursday Evenings) ❑ $25.00/hour (two (2) hour minimum) Room Fee ❑ $15.00/hour (two (2) hour minimum) Room Fee ❑ $30.00 Cleaning/Staffing Fee ❑ $25.00 Cleaning/Staffing Fee ❑ $150.00 Refundable Deposit O $50.00 Refundable Deposit ❑ Large Conference Room (Friday -Sunday Evenings) ❑ Small Conference Room (Friday -Sunday Evenings) ❑ $38.00/hour (two (2) hour minimum) Room Fee ❑ $20.00/hour (two (2) hour minimum) Room Fee ❑ $30.00 Cleaning/Staffing Fee ❑ $25.00 Cleaning/Staffing Fee ❑ $150.00 Refundable Deposit ❑ $50.00 Refundable Deposit (Room rentals during normal business hours are free, cleaning fee and deposit will still be required) (Rates for non-residents see attached policy for rates of use) ❑ Gem Lake or White Bear Township Resident ❑ Yes ❑ No (GeFa Lake and White BeaF Township residents will be given a 0 diseount on the large reem rental) ADDlicant Information Name: Address: City: Home Phone: Email: Rental Information Organization: Organization Address: Date of Rental: Purpose of Rental: Cell Phone: Time: State: Zip: to ._.._.._.._.._.._.._............................................ - - - ................................................ Heritage Hall Rental Application Page I of 4