Online Booking Application Application Form - Facility Hire Applicant DetailsName of organisation/group*Contact person*Position*E-mail* Address*Suburb*Postcode*MobileTelephone (BH)Telephone (AH)Event DetailsPlease note we do not hire the facility for private functionsProposed day(s)*Proposed date(s)*Proposed start and finish times*Please provide a brief description of the activities/services/event you wish to conduct at the centre*Estimated number of people attending the activity/service*Room(s) required* Meeting Room 2 Meeting Room 3 Meeting Room 4 Large Hall & Kitchen Small Hall Kitchen Do you intend to provide food or drinks during your activity?*YesNoIf yes, provide details*Do you intend to provide alcohol during your activity?*NoYes - BYOYes - Sell (Liquor Licence must be provided)Liquor licenseWhat equipment do you require? Wireless Microphone Corded Microphone Microphone Stand PA System Stage Lecturn Laptop Stand Tables - Oval Tables - Trestle Chairs Whiteboard Room Divider Urn(s) WiFi Projector Projector (hours)*($10 for the first 3 hours, $10 per hour thereafter)Approximate number of tablesApproximate number of chairsWhat equipment do you intend to bring?NotesGroup DetailsIs your group* Not for profit Community Group Not for profit Community Agency Business Is your group incorporated? Yes No Since (date) Does your group have public liability insurance coverage?* Yes No Public liability insurance expiry date:* Brief description of your organisation’s purpose and target group, e.g. families, young people, ethnic group etc.Where does your group currently meet?How many of the people participating in your activity live in City of Casey?How many of the people participating in your activity live in City of Cranbourne?Agreement I hereby apply to hire the Balla Balla Centre facilities details as completed above. I certify that I have been issued with BBCC Conditions of Hire Agreement which I have read and understood and I will comply with all conditions detailed in that document. Where the hirer is a company or incorporated association, I am authorised by the hirer to complete the Application Form on the hirer’s behalf and acknowledge that I am personally responsible for ensuring that the hirer complies with the conditions of hire. The hirer agrees to pay the public liability insurance charge of $25per instance of hiring, or provide a current copy of Hirer’s Public Liability Insurance Certificate. The hirer(s) hereto agree to indemnify and to keep indemnified and to hold harmless the Council, its servants and agents and of each of them from and against all actions, costs, claims, charges, expenses and damages whatsoever which may be brought or made or claimed against it or any of them arising out of or in any way related to the hire of the facility herein. Applicants Name* First Last Witness Name* First Last Witness Address*I Agree to the Terms and Conditions* I Agree This iframe contains the logic required to handle Ajax powered Gravity Forms.