Exit AFFILIATE APPLICATION (20-21) 1. Question Title * 1. CONTACT DETAILS REGISTERED NAME(Organiser/ Committee) Contact Name Address Suburb State Postcode Email Telephone Mobile Fax Question Title * 2. Are you: a Club a Committee an Association a Stock Contractor an Event Organiser Other (please specify) Question Title * 3. Which of the following associations will you be affiliating through for your event? Australian High School Rodeo Association (AHSRA) Central Rodeo Cowboys Association (CRCA) National Rodeo Council of Australia (NRCA) Northern Cowboys Association (NCA) North QLD Rodeo Association (NQRA) Rodeo Services Association (RSA) Other (please specify) Question Title * 4. MAIN Event Details Date(s) of Event Place of Event (incl. Suburb & P/code) Question Title * 5. Which event activities will you be conducting under this affiliation? (Tick all that apply) Rodeo Bull Ride Bull & Bronc Bulls, Broncs, Barrels Campdraft Practise Day Horsemanship Clinic Stockman's Challenge Bikehana (Motorbike Gymkhana) Camel Race Bronco Branding Barrel Race Team Penning 'Timed Event' Jackpot School Bush Sprint Races Gymkhana Horse Sports Day Other (please specify) Question Title * 6. Please upload copy of your event program if any of your activities are listed as 'Other' or are not listed in one of the options provided in Question 5. PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Please upload copy of your event program if any of your activities are listed as 'Other' or are not listed in one of the options provided in Question 5. Question Title * 7. Do you require cover under the NRCA group insurance policies for: (Tick all that apply) Public Liability ($20 million indemnity) Personal Accident (Riders, Workers, Officials) Question Title * 8. If applying for Personal Accident Insurance Affiliation in this application, please list 'estimated' number or riders, officials and/or workers per day *Personal Accident Cover is Compulsory for all RODEO riders SENIORS JUNIORS CAMPDRAFT /GYMKHANA (Senior and/or Junior) BRONCO BRANDING/ STOCKMAN'S CHALLENGE (Senior and/or Junior) OFFICIALS/WORKERS Question Title * 9. If conducting more than one event during the policy period, please list all events requiring insurance below. (Skip this question and go to Q10 if this does not apply) Event 2 - Include Place of Event, Date(s) of Event, Type of Event Event 3 - Include Place of Event, Date(s) of Event, Type of Event Event 4 - Include Place of Event, Date(s) of Event, Type of Event Event 5 - Include Place of Event, Date(s) of Event, Type of Event Event 6 - Include Place of Event, Date(s) of Event, Type of Event Event 7 - Include Place of Event, Date(s) of Event, Type of Event Event 8 - Include Place of Event, Date(s) of Event, Type of Event Event 9 - Include Place of Event, Date(s) of Event, Type of Event Event 10 - Include Place of Event, Date(s) of Event, Type of Event Question Title * 10. Do you have a COVID-19 Safety Plan in place for your event? Yes No Question Title * 11. If Yes, please upload copy UPLOAD PDF/JPG Covid-19 Plan PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File UPLOAD PDF/JPG Covid-19 Plan Question Title * 12. If no, NRCA CovidSafe Safety plans and guidelines are available to all affiliates. Please indicate if you would like a copy supplied. Yes No Question Title * 13. TERMS & CONDITIONS OF AFFILIATION (By clicking each check box, you agree to accept the terms and conditions of affiliation provided by the National Rodeo Council of Australia Ltd) I/WE UNDERSTAND National Rodeo Council of Australia (NRCA) has sourced group insurance policies through an independent Australian Financial Services Provider (AFS) for the benefit of its members and affiliates. I/WE UNDERSTAND Committees, Associations, Promoters and/or Stock Contractors, who are 'organising' an affiliated rodeo event MUST hold a current 'Public Liability' insurance policy for the event, which includes Rodeo activities. I/WE UNDERSTAND AND ACKNOWLEDGE Personal Accident insurance cover is COMPULSORY for all Participants including Competitors, Students, Officials and Workers (if not covered by workers compensation) and applications must be submitted directly to the National Rodeo Council of Australia (NRCA) office via this document or in a separate document PRIOR to event. I/WE UNDERSTAND If a rodeo event is DUAL affiliated, Participation Lists and Registration fees must be sent directly to the National Rodeo Council of Australia (NRCA) office NO exceptions. I/WE UNDERSTAND This policy does not have a Workers Compensation component and if we employ anyone in our business or under our committee/association (where we pay PAYG tax to the ATO) we are required by law to hold an adequate Workers Compensation policy OR if using the services of a sub-contractor, we understand and acknowledge the sub-contractor should have their own work cover insurance in place. If no work cover insurance is in place, we understand a personal accident policy is required and can be supplied through the NRCA office. I/WE UNDERSTAND Release and Waiver forms must be signed by each participant (rider, worker, official) entering the arena and forwarded to the NRCA office via fax/email or post within seven (7) days from the date of the event. *The Release and Waiver Form will be provided to your nominated contact on receipt of your registration fees. I/WE UNDERSTAND Payment for event affiliation fees must be paid prior to the event, while payment for participation fees along with a copy of judges sheets and a completed reconciliation form must be submitted no more than 7 days after the event. I/WE UNDERSTAND AND ACKNOWLEDGE We, the Committee, Association, Promoter and/or Stock Contractor, hereby acknowledge the granting of insurance cover for our nominated event under a group insurance policy arranged by the National Rodeo Council of Australia creating a debt due and payable prior to the event (Public Liability) and within (7) days after the event (Personal Accident) for the total amount of premium due. We further agree non-payment of registration fees renders each Committee member jointly and personally liable for the outstanding amount. I/WE UNDERSTAND AND ACKNOWLEDGE the group policies provided by the National Rodeo Council of Australia have a Coronavirus Absolute Exclusion. Notwithstanding any other provision (including any communicable disease extension), no cover is provided under these policies for any claim, loss, cost or expense of whatever nature directly or indirectly arising out of, contributed to by or resulting from coronavirus disease (COVID-19), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or any mutation or variation thereof.This exclusion also applies to any claim, loss, cost or expense of whatever nature directly or indirectly arising out of, contributed to by or resulting from:- any fear or threat (whether actual or perceived) of; or - any action taken in controlling, preventing, suppressing or in any way relating to any outbreak of; coronavirus disease (COVID-19), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or any mutation or variation thereof.’ EFFECT OF THIS DOCUMENT: I acknowledge that I am competent and fully aware of the contents of this document, that I am not affected by any intoxicating liquor/drug at the time of this submission and that I am agreeing to it of my own free will without any threat or promise of inducement being offered by the National Rodeo Council of Australia Ltd. and/their agents. YES, I have read, understand and agree to each of the TERMS & CONDITIONS as set out above. Question Title * 14. Do you have any other comments, questions, or concerns? Page1 / 2 50% of survey complete. Next
