Application to Consume on Alcohol on Shire of Coolgardie Premises.

Name of Organisation

Name of Applicant*

Postal Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Email Address*

Phone*

BOOKING DETAILS

Facility requested*

Number of Persons.*

Purpose of Function: *

Special Instructions/ Additional Information*

Application Type*

Please note

*If you are supplying, distributing, or selling alcohol, please provide an Alcohol Management Plan with your completed application.

BOOKING DATES & TIMES

Alcohol Consumption Policy 3.8 states

Monday – Thursday 11am-10pm

Friday and Saturday 11am – 2am

Sunday 11am – 9pm

Day(s) Requested (E.g., Monday, Tuesday)*

Date(s) Requested*

Start Time*

Finish Time*

Do you agree to adhere to the approval conditions (please see link above to download full approval conditions.) By ticking yes, you confirm agreement with the approval conditions.*

Yes

APPROVED Yes / No

APPROVED NO

YES __________________________________ __________________

Signed: Chief Executive Officer Date