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Survey
Video Conference Booking Form
Business or Hirer's Details
*
Indicates required field
Business Name
*
Name of Person making booking
*
First
Last
Email
*
Purchase Order #
*
Is this a new Account?
*
Yes
No
Paying by
*
Invoice
Cash
ABN (if a business booking)
*
Postal Address (for invoicing)
*
Line 1
Line 2
City
State
Zip Code
Country
Purchase Order # (if required)
*
Booking details
Date
*
Conference Start Time
*
Finish Time
*
Duration
*
# of people attending in Kununurra
*
Location details
Kununurra
Name of person attending in Kununurra
*
First
Last
For additional names and numbers please complete these in the additional information at the end of the booking form
Phone Number
*
Email
*
Remote Site/s information
Location 1
*
CRC?
*
Yes
No
Not Sure
# attending
*
Primary contact
*
First
Last
If you have more than one person attending each location - please list the primary contact here and add in names and locations at the end of the booking form under Additional Information.
Phone Number
*
IP Conference
*
Yes
No
Unsure
Please check with the location if they are not a CRC, and ask them if they have IP capabilities on their Video Conferencing Equipment
Technical Support contact
*
First
Last
Please list the person who is the technical contact for the site
Email
*
Phone Number
*
Brand of Equipment (if not a CRC)
*
If you require more than one other location to link in (ie Broome, Derby, Wyndham, Perth and Kununurra) please complete the following for the additional sites
Location 2
*
Please only complete this section if you have more than one other site - ie two or more sites other than Kununurra
CRC?
*
Yes
No
Unsure
# attending
*
Primary contact
*
First
Last
Phone Number
*
IP Conference?
*
Yes
No
Unsure
Technical contact
*
First
Last
Please list the person who is the technical contact for the site
Email
*
Phone Number
*
Brand of Equipment (if not CRC)
*
Location 3
*
CRC?
*
Yes
No
Unsure
# attending
*
Primary Contact
*
First
Last
Phone Number
*
IP Conference
*
Yes
No
Unsure
Technical Contact
*
First
Last
Email
*
Phone Number
*
Brand of Equipment (if not a CRC)
*
Refreshments (Kununurra)
*
Tea/Coffee
Packet Biscuits
External Catering (please include in additional information)
None required
Additional Information
*
Please fill in additional information if you have more than one person attending each location.
Room Requirements (Kununurra)
*
Conference Room (seats max 12 for video conference)
Hot Office (seats 1 or 2)
Equipment / Staff (Kununurra)
*
On Site Support (ICT)
Laptop
Offsite Video Conferencing equipment (Kununurra townsite only)
Data Projector
Whiteboard
None
Conditions of Hire
1. I am the authorised person to sign for the hire of equipment and/or room(s) and have provided any necessary paperwork (Purchase Order)
2. I accept that the rooms are to be left in a clean condition prior to the end of the hire period.
3. I accept that extra costs may be charged for cleaning if condition 2 is not met.
4. Should repair of any equipment result from damage or careless handling. I will accept and pay the repair costs, with prior notification.
5. If I use the equipment or room for longer than the agreed period as detailed on this form, I will agree to pay for the extended period at the same rate.
6. Once the room/equipment is booked, cancellation fees may apply.
a. 48 or more hours – no fee
b. 24-48 hours’ notice – 50% of total
c. 0-24 hours’ notice – 100% of total
7. Refreshments must be pre ordered at time of booking, costs will apply.
8. Any other services required on the day, will be charged at our standard rates
.
Name of person agreeing to the conditions
*
First
Last
I have read and understood the Conditions of Hire.
I agree to the terms and conditions of hire as outlined above
*
I agree
I do not agree
Email
*
Phone Number
*
Book