Clubs & Hotels Centre Registration Form

Club/Hotel Name:
Required
Full Address:
Required
Town/City: Required Post Code:
Required
Telephone:
Required
Fax:
Required
Email:
Required
Please enter a valid email
Website:
Date Commenced Trading: Required

Facilities Check List

TAB Pokies Bar Restaurant Accommodation Parking Disabled Access Swimming Pool
Gym Day Spa Sports Field Function Facilities Bistro Live Entertainment Tennis Courts Sauna
Other (specify):
Special Instructions:
Where would you like your screen installed?
Estimated Annual Footfall:
Contact Name:
Required		 Position:
Required
I agree to the terms and conditions and am duly authorised to sign for the grantor:
Date:
Day
Required		 Month
Required		 Year
Required