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Lisburn City Council

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Please complete the following form:

I hereby apply, subject to the conditions of let, for the use of facilities detailed below at the above Centre.

Name of Organisation (if
applicable):
Address:
Telephone Number:



Applicant's Name:
Applicant's Address (if
different):
Telephone Number
(daytime):
Telephone Number
(evening):



Name and address of Treasurer or person to be contacted regarding payment for rooms (if different from above)
Treasurer Details:
Treasurer Telephone
Number:



Purpose of Booking:
Date, Time and Room
required (1):
Date, Time and Room
required (2):
Date, Time and Room
required (3):
Date, Time and Room
required (4):
Room layout, number of
chairs / tables required,
etc:
Other facilities required
(kitchen, AV facilities,
etc:



The applicant hereby agrees to be bound by the conditions of hire, a copy of which he/she has received and by the scale of charges applicable and agrees that the delivery of the confirmation of booking shall be binding acceptance of this offer.



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