Isle of Wight Council

STATEMENT OF COST FOR PRIVATE HIRE OF MEDINA THEATRE

	Fairlee Road Newport Isle of Wight PO30 2DX Tel : 01983-527020 - Fax : 01983-822821
	Statement of cost for hire of Medina theatre - This form must be taken to the theatre box office to be completed along with the Application form for hire of Medina Theatre. NOTE: Completion of both forms does not confirm booking. All fields marked with a * are required entries

For Office Use Only: Contract number ...............................................

Event details

*	Date of event
*	Hirer
*	Event
	Hire charge

Accommodation

	Small dressing rooms	1      2      3     4
	Large dressing room	Yes No
	Scene dock	Yes No
	Rostra	Yes No
	If chairs are required on stage, please state how many

Rehearsals

	First rehearsal:		From	To
	Second rehearsal:		From	To

Performance timings

	Advance party
*	Start

Interval

Duration (suggest 20 minutes)

*	Finish
*	Clear of theatre

Other services

*	Ticket printing	Yes No
*	Hire of upright piano	Yes No
*	Hire of Steinway grand piano	Yes No
*	Tuning of piano	Yes No
*	Hire of 16mm film projector, projectionist and screen	Yes No
*	Press advertising (see advertising form)	Yes No
*	Security/Stewards	Yes No
*	Merchandising table	Yes No

Total Cost

GRAND TOTAL PAYABLE

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	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy . Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box

Date printed: 08/03/2013