Fillable Form Fm-7-301 - Equipment Loan Application Form printable pdf download

PO Box 3130, Bundaberg QLD 4670

190 Bourbong Street, Bundaberg QLD 4670

1300 883 699

4150 5410

ceo@bundaberg.qld.gov.au

ABN 72 427 835 198

Equipment Loan

Application Form

This equipment is available for use by not for profit/community based or charitable organisations or

individuals that demonstrate strong community benefit, need and support. All applications must be made

using this form and applications must be received at least six (6) weeks prior to the date the assistance is

required.

Applications are assessed at the end of each month. Notification of outcomes will be advised within ten (10)

working days after the 1

day of each month. Successful applicants must acknowledge Council’s

contribution in all publicity relating to events or activities. The Hirer may be required to display

promotional signage in recognition of Council support.

Before filling in this application form, please read all the information in the Conditions of Use. ALL

EQUIPMENT IS REQUIRED TO BE COLLECTED AND RETURNED BY THE HIRER (excluding waste bins

& mobile stage) – Refer Collection Location information in the Terms & Conditions.

Hirers must hold Public Liability Insurance. Bundaberg Regional Council accepts no responsibility

for any injury or damage caused by the equipment during loan period.

Name of Hirer (Organisation/Group):

Bargara Triathlon Club Inc

Authorised contact person:

Guy McNicol

Contact Address:

PO Box 8394, Bargara 4670

Email:

.au

Phone Number:

(H)

(W)

(M)

41592918

41311828

0409799616

Name of Event/Activity:

Mon Repos Triathlon

Event/Activity Duration:

To:

6am 21/04/2013

10am 21/04/2013

Equipment/s Location:

Mon Repos Beach Carpark

Collection/Return Dates:

To:

15/04/2013

22/04/2013

Waste/Recycle Bins:

Delivery Date:

Pick Up Date:

Mobile Stage:

Delivery Date

Pick Up Date:

Exact Stage Location

(attach map if possible)

□

Have you booked your Venue/Park Booking:

YES

(All activities in Parks, on or in Council land or Facilities must be booked with the appropriate Department)

Is Power required for Park Event

(Only in locations where this access is ordinarily available)

□

YES

Work Order No

(Office Use Only)

Preferred

Office Use Only

Collection/Return location

Item

available

requested

(Bundaberg, Childers, or

Approved

Gin Gin)

Marquee 6mx3m

(including weights)

Marquee 3mx3m

(including weights)

Witches Hats 750mm

Bollards (with base)

Portable PA System

Bundaberg – Community

(including

Services Branch (Only)

microphone)

Promotional Signage –Pull Up

Banner

(not for outside use)

Promotional Signage – Teardrops

Bundaberg

Bundaberg Regional Council is collecting this information in order to comply with its responsibilities and obligations as a Local Government. The information

will only be used by Council Officers or Agencies which may have a legitimate need for the information to process applications or the like. Your information

will not be given to any other person or Agency until you have given us permission or we are required to by law.

FM-7-301 Rev.2 09/05/12 P1 of 3