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a booking form

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FOR REGULAR APPLICATIONS:<br />

DATES THAT WILL NOT BE REQUIRED THROUGHOUT THE YEAR<br />

(eg: School Holidays, Public Holidays)<br />

NATURE OF APPLICATION<br />

NUMBER OF PEOPLE<br />

SPECIAL REQUIREMENTS/AUDIO REQUIREMENTS<br />

Number of chairs required<br />

Number of tables required<br />

Will there be alcohol at your function? Yes No<br />

Are you an incorporated not-for-profit organisation?<br />

(If yes, please attach evidence of this) Yes No<br />

If we receive calls from attendees at your event, do we have your permission<br />

to give your contact details to the callers? Yes No<br />

I hereby acknowledge that I have read a copy of the 'Conditions of Hire’ <strong>form</strong> as attached<br />

and agree to abide by the conditions therein. I acknowledge that the costs incurred due to<br />

breakage, damages or not leaving the premises in a clean and tidy condition will be charged<br />

to my account and any additional costs shall be rendered by myself or the organisation named<br />

above.<br />

Signature:<br />

Date:<br />

Please make cheques payable to the “Asthma Foundation WA”.<br />

***Incomplete Applications Will Not Be Accepted***<br />

Office Use Only<br />

Date Received<br />

Staff Member

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