Name of organization

Nominated contact person

Postal address

Suburb

State

NSWVICWAQLDSANTTASACT

Postcode

Phone

Email

Is your organisation based in the City of Hawkesbury?

• Yes
• No

Is your organisation not-for profit? *

• Yes
• No

If yes – attach confirmation of your not-for-profit status (File size must not be larger than 4 MB. Only pdf, jpg and png file types are accepted)

Does your organization have a Public Liability Insurance policy to the value of $10M *

• Yes
• No

If yes – attach a copy of the Public Liability Insurance policy (File size must not be larger than 4 MB. Only pdf, jpg and png file types are accepted)

Name of facility to be hired

Date of hiring

Do you have a written quote for the cost of hiring the facility? *

• Yes
• No

If yes – attach a copy of quote for hiring the facility (File size must not be larger than 4 MB. Only pdf, jpg and png file types are accepted)

Declaration

Have you attached confirmation of your not-for-profit status? *

• Yes
• No

Have you attached a copy of the Public Liability Insurance policy? *

• Yes
• No

Have you attached a copy of quote for hiring the facility *

• Yes
• No