Email Address:
First Name:
Surname:
Business Name/Organisation:
Business/Organisation Web Site URL:
Position
Address
Suburb / Town
State / Territory NSW VIC QLD ACT TAS SA NT WA
Postcode
Business phone number
Mobile phone number
Your age group 17 or under 18-24 25-39 40-54 55 or over
What is the age of your business (years)
In which industry does your company / organisation predominately operate? Business service provider Education / Training Manufacturing Government Retail Other
- Please specify your organisation's major product / service
How many full-time equivalent (FTE) staff does your company employ?
How did you find out about Small Business September '08? Direct contact from Department of State and Regional DevelopmentContact / invitation from another organisation (please specify below)Department of State and Regional Development website (smallbiz, business etc)Online advertising / articlePrint advertising / articleWord-of-mouth (friend / colleague)Other
- If 'Other organisation' please specify
- If 'Other' please specify
Have you attended Small Business September events in previous years? Yes No
Which, if any, NSW Department of State and Regional Development event programs have you attended before? Small Business SeptemberHome Based Business WeekWomen in BusinessBusiness Advisory Service (BAS) or Business Enterprise Centre (BEC)Western Sydney Business Centre Seminar / Western Sydney Manufacturing WeekExporters Network / Trade event, mission or exhibitionOther Departmental regional eventOther Departmental metropolitan eventI have never attended any Departmental events before
Privacy Statement
The personal information you provide in the Small Business September coordinator registration form will be used by the Department of State and Regional Development (DSRD) to register you to attend Small Business September 2008 events and/or register Small Business September 2008 events. It may be used to conduct analyses of Small Business September events, conduct market research and to send publications and other information to you from time to time. If you consent, your details will be provided to external event partners and sponsors of Small Business September 2008. You have the right to access and/or correct any personal information which the DSRD or any other body hold about you subject to the Privacy and Personal Information Protection Act 1998 (NSW). For further information on our privacy policy, including your rights to access and/or correct your information, please visit http://www.smallbiz.nsw.gov.au/smallbusiness/Privacy/.
I consent to my personal information, including contact details being disclosed to the external event partners and sponsors of Small Business September 2008.
I do not wish to be contacted by the Department of State and Regional Development.
I do not want my contact details shared with sponsors or partner organisations.
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