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Register an Event

1 Section 1: Event Organiser Details

2 Section 2: Event Information

3 Section 3: Declaration and Disclaimer

Name of organisation*
Website*
Contact Person
Title
Name*
FirstLast
Position*
Contact Number*
Email*

Event Details
Event Name*
Event Category*
Event Description*
Is this a free event?*
- Yes
- No
Event price*
Is there concession pricing?*
- yes
- No
Please specify concession price*
Upload an image
Upload event documentation
Event Start Date/Time*
Please use format YYYY-MM-DD HH-MM
Event End Date/Time
Please use format YYYY-MM-DD HH-MM
Venue Details
Venue Name*
Street Address*
Suburb*
Postcode*
Is this venue wheelchair accessible?*
- Yes
- No
Booking Details
Are bookings required?*
- yes
- no
Can attendees book online?*
- Yes
- No
Please provide web address*
Phone number for bookings
Date bookings close*

Declaration and Disclaimer
1. I am an authorised representative and have the authority to act on behalf of the named Organisation.
2. I have read the Declaration and Disclaimer, and acknowledge and agree that it is binding on the Organisation.
3. I declare that the information given on this Registration Form is true and correct.
4. I agree that the activities carried out by the Organisation must be carried out in accordance with all applicable laws.
5. I confirm that the Organisation has obtained appropriate insurance to cover the risks arising out of the Organisation's activities.
6. I agree that COTA Victoria and their employees, agents and contractors, will not be responsible for any loss or damage (including but not limited to a negligent act or omission) the Organisation suffers as a result of the Organisation's inclusion in the COTA Victoria Event Calendar.
7. I agree that the Organisation will indemnify the COTA Victoria and its employees, agents and contractors against any loss, damage or legal liability whatsoever in respect of any damage to property or finances suffered by any third party arising from the Organisation's inclusion in the COTA Victoria Event Calendar.
8. I agree that the Organisation must not represent to any third party that inclusion on the COTA Victoria Event Calendar represents any form of endorsement by the Organisation.
Full Name*
Position Title*
Contact Phone*
Email*

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