All service providers must read the Hunter Homeless Connect Inc. Code of Conduct before completing the application form. Please click here to read, before proceeding with your application. SERVICE REGISTRATION DETAILS Organisation Name * Sub Agency Title Your unit's title within your organisation Service being offered on the day * Details of service and products being offered on the day. This will assist with service provider stall position and event planning. Postal Address * City * Postcode * Organisation Contact Name * Details of organisation contact completing the online registration. Business Phone * Mobile Organisation Contact Email Address * Please provide details here so that important pre-event communications can be sent to a general contact within the organisation, in addition to staff members attending the event. DETAILS OF STAFF ATTENDING ON THE DAY Primary staff member attending * Please provide details of staff member who will be attending on the day, so that important pre-event communications can be delivered to the relevant person. Primary staff member's email * Primary staff member's mobile Secondary staff member * Please provide details of secondary staff member to ensure important pre-event communications are received in the absence of primary contact. Secondary staff member's email * Other staff members attending Please provide approximate numbers of staff who will be attending the event on the day. HUB PREFERENCE You may have services appropriate to more than one hub. If so, please indicate which hub/s you feel relevant to those services. Please also ensure that you provide details of the services and/or products you are providing on the day in the field located at the top of the registration form, to assist us with placing you in the most relevant hub (alongside similar services) at the event. Each hub will be assigned a volunteer Hub Leader who will assist the HHCD Event Coordinator with pre-event requirement communications. They may be in touch with you in the lead up to the event to ascertain any special requirements. The Hub Leader is responsible for ensuring that your involvement in the event is as seamless as possible, so it is important that you respond to any of their communications. Hub Preference Catering (Provision of food & beverages) Connections (Library Facilities/TAFE Outreach/Education Support) Entertainment (Music) Family Support (Services that are dedicated to supporting families in general, including children) Health Screening & Information Housing & Accommodation Legal & Financial Opportunities (Social Work, Employment & Training) Pets (Pet Services and Products) Sport & Recreation Wellbeing (Hair / Massage) Youth PUBLIC RISK INSURANCE DETAILS (NB Self insured government departments are not required to supply a copy of their certificate of currency) Have you read the Code of Conduct? * Yes I have Insurance? Yes No If yes, please attach current Insurance Certificate of Currency below. Name of Insurer Policy Number Expiry Date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year201920202021202220232024 Type of Cover ABN/ACN Email Address Insurance Certificate of Currency Files must be less than 2 MB.Allowed file types: gif jpg jpeg png txt rtf pdf doc docx rar zip.