ACTIVITY / WORKSHOP PROVIDER EXPRESSION OF INTEREST Name of Activity / Workshop Provider*Type of activity/workshop*Name* First Last Phone*Mobile PhoneEmail Address* Subscribe to our newsletter. Emergency Contact Name Name Emergency Contact PhonePublic Liability*Accepted file types: pdf, jpg, png, gif, doc.Please upload your certificate of Public Liability InsuranceI/We give consent to use the photos for all festival reports & publications Yes No Description of Activity*In not more than 200 words please provide a short biography of yourself or groupRequirements*How much will you charge per session?*How long will your sessions run for?*Are you Registered for GST?* Yes No ABN*Website/Facebook Page Conditions and Guidelines* I have read and agree to the conditions and guidelines Click to view conditions and guidelines 1. This EOI does not constitute acceptance. Final approval is at the discretion of the festival organizing committee. I/We will be notified in due course, whether or not I/we have been accepted. 2. I/We understand that it is my/our responsibility to look after my/our equipment & obtain sufficient personal injury and property damage liability insurance. Africultures Festival shall not be liable for any personal injury and equipment damaged or lost during the festival. 3. I/We give permission to Africultures Festival to take photos and/or videos of my/our performance and Africultures will seek my consent prior to using these photos and/or videos in any of their or their sponsors marketing or promotional publications. 4. I/We understand that religious or political materials are not permitted for promotion at this festival. CAPTCHASignature*Date* This iframe contains the logic required to handle Ajax powered Gravity Forms.