= Required Fields

Online Form - Agreement for Keys- Shire of Coolgardie Facilities

Please fill our the form below to request keys for a Shire of Coolgardie Facility.

Terms and Conditions

Please click here to view the terms and conditions of hiring a Shire of Coolgardie Facility.

 

 

Which town is the facility you are requesting keys for in

USER GROUP / ORGANISATION CONTACT DETAILS

PRESIDENT/CHAIR PERSON  - Name

SECRETARY

TREASURER

AUTHORISED FACILITY CONTACT

Key Holders Please indicate up to 2
Do you agree to adhere to the terms and conditions (please see link above to download full terms and conditions.) By ticking yes, you confirm agreement with conditions.