Instructions: Please Print Clearly Using Black Pen in the Spaces Provided

Banner Site Hire Application Form

Privacy City of Perth The personal information collected on this form will only be Council House used by the City of Perth for the sole purpose of providing 27 St George’s Terrace, Perth requested and related services. Information will be stored GPO Box C120 Perth securely by the City and will not be disclosed to any third Western Australia 6839 parties without your express written consent. ABN 8378 0118 628

Copyright Phone: (08) 9461 3191 Facsimile: (08) 9461 3083 I authorise the City of Perth to reproduce any attachments [email protected] provided with this form for internal purposes only. www.perth.wa.gov.au

Instructions: Please print clearly using black pen in the spaces provided.

1. CUSTOMER DETAILS Organisation: Contact Name: Address: Telephone: Postcode: Mobile: Facsimile: E-mail: Postal Address: If same as above leave blank Postcode:

2. BOOKING DETAILS – (maximum of 2 consecutive weeks or 1 week if event is one day only)

Banner Site: Date From: Date to: Banner Site: Date From: Date to: Banner Site: Date From: Date to: Banner Site: Date From: Date to: Banner Site: Date From: Date to: Banner Site: Date From: Date to: Banner Site: Date From: Date to: Banner Site: Date From: Date to:

Please refer to Banner Locations and Banner Specifications documents for information regarding fees, locations and specifications.

F0038 (30/11/10) CSC P1011144 3. EVENT OR ACTIVITY DETAILS

Name of Event:

Location:

Event Date/s:

Event Description (brief):

YES NO Banner Design Included with Application please circle

NB. If not included with this application the Banner Design must be submitted for approval a minimum of 3 months prior to banner installation date.

4. AGREEMENT

I have read Policy 18.5 Hire of City Banner and Flag Sites and understand this forms part of the terms and conditions of Banner and Flag Pole Hire within the City of Perth.

Signature: Date:

Response Time: 2 Working Days from date of receipt

F0038 (30/11/10) CSC P1011144