Type of Organisation?  *  Voluntary   Statutory   Business 

Registered Charity Number (if applicable)

Name of applicant/hirer  *

Address  *

Contact Number  *

Email  *

Use of room

Number of users

Date required

Order number

Time from

Time until

Public Liability Insurance  Yes   No 

Room Requirements ..i.e. tables, chairs, refreshments, format

Bringing own equipment please specify