Vendor Registration Form

Vendor Name*

First Name*

Last Name*

Email*

Office Phone

Mobile

Is your business based in the Gympie Region?*

Yes

No

Product*

Please supply details of products to be available at event (types of food, clothing, etc)

Image of Stall

Please upload a picture of your stall

Drag and drop files here or

Insurance*

Please note: It is a requirement that each vendor must have Public Liability Insurance to the sum of $20,000,000 (20 million) and Gympie Regional Council noted as an interested party My business has the required amount of public liability insurance in place to attend a Gympie Regional Council event

Yes

No

Privacy Statement

In providing any personal information, please note that you are agreeing to the possible transfer of your information outside Australia via the internet under s33 of the Information Privacy Act 2009. If for any reason you are unable to agree to these terms, please contact council on 1300 307 800 to discuss alternate arrangements.

Send me a copy of my responses