Event Manage

Amplify Equipment Request Form

Please complete and submit this form.

Your Name*:

Your Email*:

Event Start Date*:

Event Name*:

Equipment Request Form

Are you aged 12 - 25?*:

Yes

Contact Phone Number*:

Event Location*:

Pick up is from the Mansfield Youth Centre at 7 Erril St | Monday to Friday 9am - 5.00pm. When will you pick up?*:

Office Use Only: Council Staff who signed out:

Equipment Available - equipment may not be available, council will be in touch to confirm your booking*:

PA System - Small bose S1 Pro single speaker - Up to 40 people - workshops and presenters (Value:$1000)

Total Value: -

PA System - Single speaker - 40 - 70 people - solo musician, workshops and presenters (Value:$700)

Total Value: -

PA System - Single speaker - 40 - 70 people - solo musician, workshops and presenters (Value:$700)

Total Value: -

PA System - Double Speaker - 70 - 150 people - solo or duo musician, workshops and presenters (Value:$1800)

Total Value: -

Headset and lapel microphone cordless UHF (Value:$350)

Total Value: -

Weebill 3S Camera Gimble (Value:$530)

Total Value: -

Total: -

Terms and Conditions • We do not deliver, pick up only
• Equipment must be returned to council the first business day after the event to the same place of pick up.
• Equipment must be stored safely until returned and must be returned in the same condition as borrowed.
• Items are costed and will need to be replaced if damaged, broken or lost

ACKNOWLEDGEMENT OF TERMS AND CONDITIONS OF USE * :

Clear

I acknowledge

• that I am an authorised person if over 18 or an authorised parent or carer if under 18 of the person named in this agreement
• that the items will be returned in the same conditions as received
• that I am aware of and agree to the Terms and Conditions applicable to the use of the borrowed listed items and that non-compliance may lead to me being restricted or denied future use of such items

SAVE