Wainuiomata Rural Community Assn. Inc.

 

 

Name of Requesting Organization:

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Name and Signature of Requesting Applicant:

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 Job Title:

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 Purpose for Request:

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  Dates & Times of  requested Footage:

Format           DD/MM/YY      24 hr Time    1pm  =    13    :   00

Start Date:                                                   Start Time:

 —–/—–/—–                                              ——–: ——–
End Date:                                                     End Time:

—–/—–/—–                                               ——–: ——–

Request reviewed by :                       Date:   _ _ _/ _ _ _/ _ _ _

Camera operator:

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Committee Member 1:

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Committee Member 2:

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Request:   Accepted / Declined ( Reason if declined )

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 Footage Retrieved:             

Date_ _ _/_ _ _/_ _ _

Camera Operator:

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Committee Member:

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Footage Released to Applicant by:

Name:  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _   Date: _ _ _/_ _ _/_ _ _

Footage Received by Applicant:

Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date:_ _ _ /_ _ _ /_ _ _