What is your name?

What is your e-mail address?

Phone number?

What is your postal address?

What country are you based in? Aotearoa Papua New Guinea Fiji United States Sweden Germany Ecuador Australia Saudi Arabia Kemp Land Serbia Tibet Samoa Antarctic Confederation Cook Islands Tuvalu Russian Federation Tonga Philippines Upper Yafa Malaysia East Timor Niue Port Maria Moluccas India Tokelau Islands Maldive Islands Yemen Free Vinland Egypt Bosnia Brazil Waiheke Island Denmark Brunei Albania United Arab Emirates Guatemala Occussi-Ambeno Egypt Greece Sedang Italy Great Barrier Island Switzerland Liegerland Chile Panama Montenegro Hawaii other Preferred space? Main Hall Red Room Oval Room other

Date required: Start time: Finish time:

Type of function? Please select best option Meeting, supper, no music Meeting, supper, live music Meeting, supper, taped music Party, music, drinking, food Party, music, no drinking, food Party, music, no drinking, no food Lecture, with food Lecture, no food, coffee Children's party, food, non-alcohol drinks Movie screening, supper, coffee Movie screening, no food, no coffee Theatre rehearsal Yoga class Music rehearsal Political meeting Concert, alcohol sold Concert, no alcohol Religious meeting Educational class other

Need a Liquor Licence for the function? No, no drinking Yes

Number of chairs needed? Number of tables needed?

I am (occupation) Student Wage worker Bank employee Housewife Photographer Retired Unemployed Sickness beneficiary Computer technician Retail salesperson Mechanic Builder Printer Librarian Manager other I am (age) 18 - 21 22-25 26-30 31-40 13-17 12 or under 41 & over I am (sex) Female Male other

Best time to ring me about this inquiry Before 8 a.m. weekdays 9 a.m. till noon, weekdays Early afternoon, weekdays Late afternoon, weekdays Early evening, weekdays morning, Saturdays afternoon, Saturdays evening, Saturdays morning, Sundays afternoon, Sundays evening, Sundays