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Online Form - Application to Consume on Alcohol on Shire of Coolgardie Premises.

Please click here to read the approval conditions for this form.

Name of Organisation

Name of Applicant

Postal Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Email Address

Telephone

BOOKING DETAILS

Facility requested

Number of Persons.

Purpose of Function:

Special Instructions/ Additional Information

Application Type*

*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 NO

YES __________________________________ __________________

Signed: Chief Executive Officer Date