Step 1 of 4 25% Personal DetailsName First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican 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 RicoQatarRomaniaRussiaRwandaRéunionSaint 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 IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneMobileEmail Website Business DetailsBusiness Name ABN Type of Business Professional Indemnity Insurance*Do you have professional Indemnity Insurance for your events? Yes No Insurance CertificatePlease provide a copy with this form. Please note: insurance policy must match applicant/business name.Max. file size: 64 MB. EquipmentEquipmentDo you require any of the following Audio Visual or Event Equipment? (Charges may apply, see Venue Hire Rates) Data Projector (charges apply) Bluetooth speakers TV (charges apply) Whiteboard Yoga Mats Yoga Blocks Yoga Mats (max 25)Please enter a number from 1 to 25.Yoga Blocks (max 25)Please enter a number from 1 to 25.Do you require chairs? Yes No Number of chairsDo you require tables? Yes No Number of tablesTable Size Small Large Type of Room set up required? Theatre Style U-Shaped Style Class Room Style Do you have any other special requirements? Event DetailsEvent Title* Expected Number of AttendeesEvent Presenter/s: Website Event DescriptionEvent ImageAccepted file types: jpg, png, Max. file size: 1 MB.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 DD slash MM slash YYYY Start Time : Hours Minutes AM PM AM/PM End Date DD slash MM slash YYYY End Time : Hours Minutes AM PM AM/PM What level of noise will your event involve? High Medium Low Quiet 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
