HHCD Service Provider Registration and Insurance Application for 2020

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/giveaways 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

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

Month

Year

Type of Cover

ABN/ACN

Email Address