MAGISTRATES COURT of TASMANIAVideo Conference Booking Request

Person Requesting Conference:Name: Telephone No.

Email: Your Reference:

Agency: Signature & Date:

Magistrates Court Matters Only:Parties Names: -v-

Court File No.: Magistrate:

Conference Details - Costs will vary for each conferenceAttendee/s to conference:

Date required:

Time (Tasmanian): Start: End:

Which site will make the Video Conference call?

Tasmanian Court Site Required:

Far End Site Details:Site Contact: Telephone No.:

Preferred Transmission Mode - ISDN or IP (please specify below):

ISDN:

IP Address:

Special Requirements:

Magistrates Court Use Only:

Please Indicate Preferred Payment Method:Tax Invoice (for existing accounts): Credit Card (Visa / Mastercard only): EFT: Attach copy of receipt

Name: Address:

Cardholder Name: WESTPAC

Card Number: BSB - 037001

Expiry Date: A/C - 267793

The booking form is to be submitted at least 24 hours prior to the scheduled court appearance

Please complete and return to appropriate Registry below:

BURNIE DEVONPORT HOBART LAUNCESTONPO Box 690, Burnie, 7320 PO Box 208, Devonport, 7310 GPO Box 354, Hobart, 7000 PO Box 551, Launceston, 7250Ph: (03) 647 77145 Ph: (03) 647 84351 Ph: (03) 616 57100 Ph: (03) 677 72945Fax: (03) 6173 0221 Fax: (03) 6173 0221 Fax: (03) 6173 0221 Fax: (03) 6173 0221Email: RegistryBurnie@justice.tas.gov.au

Email: RegistryDevonport@justice.tas.gov.au

Email: RegistryHobart@justice.tas.gov.au

Email: RegistryLaunceston@justice.tas.gov.au