Lions Event Kiosk Hire Request Application Form

Lions Event Kiosk

Hire Request Application Form
Name of Hirer/Organisation
Contact Name*

First NameLast Name
Contact Phone Number
Email Address*
example@example.com
Address of Event*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Enter event from & to date below
From Date*

DayMonthYear
Enter/Select Date
To Date*

DayMonthYear
Enter/Select Date
Comments/Questions
Should be Empty: