Club/Hotel Centre Registration Form

* Club/Hotel Centre Name
* Address
* Town/City
 		Post Code
* Telephone Invaild telephone number
 		Fax
* Email Invaild email format
Website
* Commenced Trading     Invaild Date

Facilities Check List

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

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