Print out and return the completed form to the address shown.

APPLICATION FOR BOOKING
ST. AGNES PARISH CENTRE & HALLS ANDERSONSTOWN ROAD BELFAST

Organisation———————————————————————————

Activity————————————————————————————— 

Room(s) Required—————————————————————————

Are kitchen facilities required? ——————

Approximate no of people expected——————
Is there a charge for admission?——

Is admission by ticket? ———————————
Cost of Ticket— —————

SINGLE BOOKING: Day—————————— Date————————

Time: From————————————————— To————————

BLOCK BOOKING ONLY: Days_____  Dates———————————

Time: From———————————  To———————

IS PERMISSION REQUESTED FOR THE sale OF ALCOHOL? —————

Please Note:

(1)The Parish Secretary must be in receipt of a valid occasional licence
(5 days prior to event) for inspection and display
and before alcohol is brought into premises.
(2)   All alcohol is to be removed from the premises by ——————

(3)    No alcohol may be brought into the centre without prior approval of St. Agnes Hall Committee.

Do you have your own Insurance Cover? ———————

Name of Insurers and extent of cover ————————————————

Evidence that the Policy is in force at date of event to be provided  ———————

I HEREBY AGREE TO THE CONDITIONS OF LETTING

NAME: (Block Capitals) —————————————
SIGNATURE: —————

ADDRESS: ——————————————————
OFFICE HELD : ————

TELEPHONE NO: —————————————————
DATE: ——————

Application forms with a non-returnable £50 deposit to be returned to: 

                              Secretary Parish Hall Committee

                              c/o Parish Office

                              139 Andersonstown Road

                                Tel.  90619546

ALL COMPLETED FORMS WILL BE REVIEWED BY PARISH HALL COMMITTEE.