Make a Submission - Pioneer Park Courthouse

To make a submission, please include your contact details below and the details of your submission.

Your Contact Details

Your personal details are kept confidential and only used for reporting purposes and keeping you informed.

1. What is your name?* required

Maximum 255 characters

0/255

2. What is your address?* required

Maximum 255 characters

0/255

3. What is your email address?

Maximum 255 characters

0/255

Your Organisation's details

Your organisation's name

Maximum 255 characters

0/255

e.g. The name of the community organisation or group that will be leasing the building.

Tell us about your organisation and the impact it has on shaping the creative landscape of the Northern Rivers.

* required

How would this program benefit your organisation?

* required

How many hours a week would you use the building? Can you specify when?

e.g. Mon - Friday 9 am - 5 pm or Mon 10 am - 4 pm , Tuesday 1 - 5, Saturday 8 pm - 12 am etc.

Do you have any specific access requirements? If so, let us know what.

Do you have Public Liability Insurance?

Select option

Please note your organisaton MUST have current Public Liability Insurance to lease this property

10.

Anything else you'd like to add?

11.

Please upload a copy of your current Public Liability insurance certificate

Privacy statement

Privacy Statement: Any personal data captured in this submission will be stored by Council in accordance with its Privacy Statement, Privacy Management Plan, Government Information (Public Access) Act 2009 and the Privacy and Personal Information and Protection Act 1998. Personal information captured will be used only for participation in this project and will not be disclosed to any third party without your written consent. Details of individual submissions may be made public in accordance with Part 3, Division 1, Clause 18(g) of the Government Information (Public Access) Act 2009. Personal information will only be made available by application in accordance with Part 2, Division 2 - Public interest considerations - of the Government Information (Public Access) Act 2009.