Online Community Facility Hire Form

Form
Application for Copper Coast Community Facility Hire
Select Facility
Room Type
Fees and Charges - Select Option and Organisation Type
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Function Room Half Day
Maximum 4 Hours

Free Organisation



Function Room Full Day
Full Business Day

Free Organisation



Meeting Room Half Day
Maximum 4 Hours

Free Organisation



Meeting Room Full Day
Full Business Day

Free Organisation



Total

$0.00 AUD
Kadina Town Hall Select Room Requirements
Moonta Town Hall Select Room Requirements
Wallaroo Town Hall Select Room Requirements
Kadina Library Select Room Requirements

Other
Kadina Library Additional Requirements
Organisation
ABN
Name

First NameLast Name
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Type of Function
Function Date & Time

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
** Please note: Only available during business hours
Whilst every attempt will be made to accommodate your booking request demand on the room will
dictate actual availability. You will be notified with a booking confirmation if the room is available
Start and End Time of function

Hour Minutes

AM/PM Option

Until

Hour Minutes

AM/PM Option
Estimated Numbers Attending
Will Food/ Refreshments Present
Will Alcohol Be Served
If Alcohol, Copy of Limited Liquor Licence
Copy of Limited Liquor Licence

Cancelof
$10,000,000 Public Liability Insurance
Signature
Office Use Only

Proceed to submit below
Booking Number
Insurance
Cover Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Booking Officer

First NameLast Name
Bond Paid
Receipt Number
Bond Refunded
Authorised person

First NameLast Name
Approved/ Declined
Should be Empty:

Form

Fees and Charges - Select Option and Organisation Type

Office Use Only