EVRC - Agency Membership Form » Shire of Esperance

Agency Name*

Agency ABN*

Email*

Phone*

Street Address:*

City:*

State:*

Post Code:*

Country:*

Mailing Address - Same as street address?*

YesNo

Description of Agency*

Incorporated?*

YesNoUnsure

Volunteering Roles Offered*

Number of Current Volunteers*

Number of Current Paid Staff*

Agency is a Centrelink Approved Organisation?*

YesNo

Would you like information and/or assistance with any of the following? Please tick.*

Volunteer Recruitment
The National Standards for Volunteer Involvement
Policies & Procedures
Volunteer Recognition
Writing Volunteer Position Descriptions
Risk Management
Inclusion & Diversity
Emergency / Event Volunteering
Exiting Volunteers
None
Other: Please specify below

Other (from question above):

Service Focus*

Animal Welfare
Disability Services
Education & Training
Family Services
Human Rights
Migrant Services
Seniors & Aged Care
Young People
Arts & Culture
Disaster Relief
Emergency Response
Health
Indigenous Australians
Museums & Heritage
Sport
Community Services
Drug & Alcohol Services
Environment / Conservation
Homeless
Mentoring & Advocacy
Recreation
Veteran Services
Other: Please specify below

Other (from question above):

Public Liability Insurance: Policy Number*

Public Liability Insurance: Policy Expiry Date:*

Public Liability: Insurance Company*

Have you emailed a copy of your Public Liability Insurance Policy to volunteer@esperance.wa.gov.au ?*

YesNo

Volunteer Personal Accident Policy Number:*

Volunteer Personal Accident Policy Expiry Date:*

Volunteer Personal Accident Policy: Insurance Company*

Have you emailed a copy of your Volunteer Personal Accident policy to volunteer@esperance.wa.gov.au ?*

YesNo

Volunteer Coordinator Name*

Volunteer Coordinator Job Title*

Contact Phone*

Contact Email*

Preferred Contact Method

Phone
Email

Subscribe to Esperance Volunteer Resource Centre Email List*

YesNo

Agency Representative Name*

Agency Representative Job Title*

Signature*

Date*

Collection Notice

By submitting this form, you acknowledge that the Esperance Volunteer Resource Centre collects and uses personal information for the purpose of administering its services and functions, such as maintaining accurate records, and meeting legal, reporting, and governance obligations. For more information about how we collect, use, and store personal information, please refer to our Privacy Policy.

EVRC - Agency Membership Form

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