Great Connections | Community Group Sign-Up

Please complete the below form and click Submit.
There is a $150 annual fee for organisation registration with Greatconnections.
This fee allows your organisation to request up to three projects at any one time.
Applications will be processed up to 3 business days from the receipt of payment.
You will then be supplied with a username and password.

Organisation Name	*
First Name	*
Last Name	*
Position with Organisation	*
Email Address	*
Street Address	*
	Suburb / Town * State * P/code *
Work Phone Number	*
Home Phone Number
Fax
Mobile
Website
Describe your Organisation	*
Is this the correct person with whom volunteers make their first contact? Will this person be familiar with projects listed on the website?
Yes No * If no, please fill out the contact details of the correct person to be contacted at your organisation. (* = mandatory if "No")
First Name	*
Last Name	*
Phone	*
Email Address	*
Does your organization carry workers’ compensation insurance to cover voluntary workers, irrespective of their age? Yes No *
	I have read and accept the Greatconnections terms of use and privacy policy. I also give Greatconnections permission to send me updates and information via email (You may unsubscribe at any time).
	* indicates required fields