Step 1 of 4 25% Personal DetailsName First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country PhoneMobileEmail Website Business DetailsBusiness NameABNType of BusinessProfessional Indemnity Insurance*Do you have professional Indemnity Insurance for your events?YesNoInsurance CertificatePlease provide a copy with this form. Please note: insurance policy must match applicant/business name. EquipmentEquipmentDo you require any of the following Audio Visual or Event Equipment? (Charges may apply, see Venue Hire Rates) Data Projector Computer Speakers Wi-Fi Speakers TV Whiteboard Yoga Mats Blankets Yoga Blocks Yoga Mats (max 25)Please enter a number from 1 to 25.Blankets (max 20)Please enter a number from 1 to 20.Yoga Blocks (max 25)Please enter a number from 1 to 25.Do you require chairs?YesNoNumber of chairsDo you require tables?YesNoNumber of tablesTable SizeSmallLargeType of Room set up required?(Free of charge under 20 people/ $30 for 20 people and over)Theatre StyleU-Shaped StyleClass Room StyleDo you have any other special requirements? Event DetailsEvent Title*Expected Number of AttendeesEvent Presenter/s:Website Event DescriptionEvent ImageAccepted file types: jpg, png.This will be displayed on our website once we publish the event. Ideally the image would be 1920px wide.ADVERTISING: All current and future advertising and the event must be a true representation of the above event description otherwise a new application will be required to be submitted and/or the event may be cancelled.Start Date Date Format: DD slash MM slash YYYY Start Time : HH MM AM PM End Date Date Format: DD slash MM slash YYYY End Time : HH MM AM PM What level of noise will your event involve?HighMediumLowQuiet DeclarationI the undersigned declare that: 1. The information given on this application form is accurate and complete 2. I have provided my certificate of currency for public liability and indemnity insurance 3. I have read, understood and signed the venue hire terms & conditions 4. I acknowledge that this document may remain in force for future events or bookings confirmed by my representative or me. This declaration is legally binding.Signature
