Privacy

Privacy Collection Notice

This personal information in this form is collected by Toowoomba Regional Council for the purpose of assessing the request in this form and performing related functions. Council's privacy policy is available at tr.qld.gov.au/privacy.

Applicant details

Title

First name(s) *

Last name *

Phone number

Australian Business Number (ABN) or Australian Company Number (ACN)

Postal address

Suburb

State

Postcode

Page 2

Cycle Hub Membership

Fees

There is a $50 application fee. After submitting this form, a Council officer will contact you to progress your request, advise if your application has been successful and receive payment. This usually occurs within two working days.

Declaration

I understand and acknowledge that:
- I will notify Council if my access card is stolen. If I fail to notify Council I am responsible for the use of my access card including unauthorised use by other parties.
- Access cards remain the property of Toowoomba Regional Council and will be returned at the end of the membership period and/or if requested.
- In the event where the access card is replaced due to loss, theft or damage, I will incur a card replacement fee.
- In the event of misuse of facilities, Council has the right to terminate membership.
- I will ensure no stickers or additional markings are placed on the access card.
- I will notify Council if my details change.
- Council is not responsible for any loss or damage to member equipment when on site. As a member I leave my belongings at my own risk.
- Attempts to access facilities outside of hours may result in the termination of membership(s).
- By submitting this form I indemnify the Toowoomba Regional Council against all claims and demands made.
- The information provided in this application is true and complete to the best of my knowledge.
- Council may refuse this application if it becomes evident that any information or supporting documents provided is incomplete or false.
- I approve of the information that has been provided in this application.
- I acknowledge Queensland State Laws will accept this communication as containing my signature within the meaning of the Electronic Transactions (Queensland) Act 2001.

Signature

I agree with the declaration *

Applicant name *

Date *

Form process

Memberships are limited and the submission of this form will not guarantee a Cycle Hub membership.

After submitting this form, a Council officer will contact you to progress your request, advise if your application has been successful and receive payment. This usually occurs within two working days.

An appointment will be arranged with you for pickup of your membership card and for us to show you around the facility. Photo ID is required upon pickup of your membership.

12 month memberships commence from when your swipe card is picked up.

Save and Complete Later