Contact Details

Organisation Name *

Contact Name *

Organisation Address *

Town *

Postcode *

Contact No. *

Email Address *

Preferred Contact Method *

Booking Details

Booking Date *

Booking Time/s *

Would you like to book this room for additional days? *

YesNo

Please enter additional dates and times you would like to book this room *

Purpose *

Number attending *

Do you have Public Liability Insurance? *

Insurer *

Amount of Cover *

Policy No. *

Policy Expiry Date *

Room Details

Choose your Room *

$54 Set-Up Fee (Required if room needs configuration by Council Staff).

Payment Exemption (Community Groups can hire the facilities free of charge).

You will be sent an invoice by Wellington Shire Council for the cost of Room Hire. Invoices are sent at the end of each month.

Equipment Required

Chairs

Tables

Is a display screen required?

Is a lectern required?

Is a whiteboard required?

Consent

Disclaimer: I, as named above, approve this application and in doing so, agree that Wellington Shire Council, Officers, Staff, Contractors and Agents shall be released from, and not incur, any responsibility or liability whatsoever for any accidents or injuries, or for any damage to or loss of property to the Hirer or persons associated with the Hirer. *

Terms and Conditions: I have read, and agree to, the Terms and Conditions of use. *

Privacy Statement: I acknowledge the Port of Sale Privacy Statement. *