Application to reserve a municipal room

Name of the organiser (Association XY asbl)

Surname and first name (Jean Dupont)

Address (40, Grand-Rue)

Postal code (L-3394)

Locality (Roeser)

E-Mail (jean@dupont.lu)

Mobile phone (+352 621 123456)

Landline phone (+352 26 123456)

Bank

Account number IBAN (LU00 0000 0000 0000 0000)

Room

Date of installation (21.12.2017)

Start time (08:00)

End time (09:00)

Date of the event (22.12.2017)

Start time (08:00)

End time (09:00)

Date of pick-up (23.12.2017)

Start time (08:00)

End time (09:00)

Type of event

Description of the event (…)

Required material (1.…)

Liability insuranceYes
No

Comment (It is planned to …)

ConsentI undertake to comply with the modalities described in the regulation for the use of the municipal rooms.

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Citizens

Administration communale de Roeser

40, Grand-Rue

L-3394 Roeser

Monday: 1:00 p.m.-4:30 p.m.

Tuesday to Thursday: 8:00 a.m.-11:30 a.m. and 1:00 p.m.-4:30 p.m.

Friday: 7:00 a.m.-4:30 p.m. (non-stop)

Technical hotline: (+352) 36 92 32 5000

Hotline in the event of death (weekends and public holidays, from 9:00 a.m. to 11:30 a.m.): (+352) 36 92 32 2005

info@roeser.lu

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