Arafura Athletics Stadium General Stadium Hire Form Event Date: Organisation: ABN: Postal Address: Phone: Fax: Contact Name(s): (1) (2) Email Address(es): (1) (2) Mobile Number(s): (1) (2) Approximate Number of Participants: Event Start Time: Event Finish Time: Date of Application: Arafura Athletics Stadium Map Shot Put 2 Discus / Hammer High Jump 1 Javelin 2 Javelin 1 High Jump 2 Javelin 2 Shot Discus 2 Put 1 Exit Gate Long Jump >1 2 < Long Jump > 1 Triple Jump >1 Fence Line Toilets & Canteen Control Room Change Rooms Photo Finish Athletics NT & NTIS Building g Athletic NT & NTIS Staff Parking Only a Public Car Parking >>> t e Equipment Required Please tick the Field equipment required for your booking next the related events: Javelin 400g 500g 600g 700g 800g Shot Put 1 kg 2kg 3kg 4kg 5kg Discus 500g 750g 1 kg 1.5 kg 1.75 kg Long Jump Rake Shovel Spike High Jump Uprights Cross Bar Height Bar Hire Fees and Charges Item Unit Total Number of Hours Total Stadium: hrs $55/hr Track Only: hrs $30/hr Oval Only: hrs $30/hr Lighting additional after 6:00pm: hrs $15/hr Set Up & Pack Up $50/day BBQ Hire (gas not provided) $25/day PA system with Radio Microphone $25/day Change Room 1 for First Aid Station $25/day Security Bond (refer to 16 (d) in the $200.00 Terms & Condition) TOTAL AMOUNT **GST Included** Office Use Only Late Booking Fee. $50.00 Additional Hourly Rate (applicable outside of initial hire times at $55/hr). Surcharge 15% for Weekend and Public Holiday Events. TOTAL INVOICE AMOUNT All traditional track and field equipment is provided by Athletics NT as part of the Stadium Hire. Equipment not provide by Athletics NT: • Stop Watches, Tape Measures, Starters Pistol, and Relay Batons. Bank Account Details Please provide your bank details for refund of the Security Bond: Account Name: B.S.B: Bank: NT Athletics bank details for payment of account: Account Name: N T Athletics B.S.B: 035302 Bank: 697392 Terms and Conditions of Hire Please read the Terms and Conditions of Hire. Do you accept the details outlined in the Terms and Conditions of Hire? YES NO I hereby agree to all Terms and Conditions of Hire and the Code of Conduct for the Arafura Athletics Stadium and will abide by all the related documents. Signature (1): Date: Signature (2): Date: Any damage to equipment or the facility will be required to be made good by the Hirer, refer to Clause 17 of the Terms and Conditions. Please fax, mail or handed this application to Athletics NT with payment at least 30 days prior to your Event. A late booking fee of $50 may apply if 30 days notice is not given. Athletics NT will contact you to confirm your request and will issue an invoice.