Hire Form

Your Name (required)

Organisation (required)

Postal Address

City

Post Code

Phone Home

Phone Mobile

Phone Work

Your Email (required)


Type of function to be held

Number of people attending

Date function is to be held
Until

Commencement Time:
Completion Time:

Will liquor be available for purchase at this event? Yes No 
(If yes please provide a copy of your liquor licence)

FACILITIES REQUIRED

Agreed Hire Amount

Agreed Bond

Payment Method:
 Cheque Cash EFT (Complete EFT Form)

INDEMNITY

Name

Position

Your user group agree to indemnify and to keep indemnified the Circular Head Council and/or its servants and agents against any damage or loss whatsoever and howsoever and to whomsoever caused and for all claims, costs, actions and demands in respect of the death or injury to any person or loss or damage to any property resulting as a consequence of any negligent act or omission by: Your user group
in relation to the use of Council facilities or any other ground/hall operated by the Circular Head Council and used by members of the: Your user group
It is also hereby agreed and acknowledged that the Circular Head Council will not be providing any supervision at any Council owned facilities.

By Checking this box I have read and understand the COUNCIL FACILITIES - Conditions of Use enclosed with this form. I understand that by signing this form, I am undertaking to be personally responsible for the hire of Stanley Town Hall. I the undersigned, declare that the above information is true and correct.

ELECTRONIC FUNDS TRANSFER AUTHORISATION

Deposit Details

Financial institution name: Commonwealth Bank
Financial institution address: 67 Emmett St, Smithton Tasmania
Account name for deposit: Circular Head Council
BSB No: 067 408  Account Number: 1003 3182
Does your organisation need a remittance advice? Yes No 
If yes, please provide an email address below, if an email address is not provided, a remittance will not be sent.

Email Address