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Primary Funder & Founding Partner
Expression Of Interest
Organisation
Contact Person
Position
Phone
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Organisation Web Address
Organization Social Media Accounts
(IF APPLICABLE)
Facebook Page
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Would a new defibrillator be a replacement for an existing unit, an additional unit or the only unit for the organisation?
Replacement
Additional
Only Unit
BY COMPLETING THIS FORM YOU ACKNOWLEDGE THAT YOU ARE AUTHORISED TO ACT ON BEHALF OF THE ORGANISATION YOU ARE REPRESENTING. COMPLETING THIS FORM IS NOT A GUARANTEE THAT SUNBURY CONNECTED COMMUNITIES WILL PROVIDE A DEFIBRILLATOR TO THE NOMINATED ORGANISATION. IF A DEFIBRILLATOR IS SUPPLIED ALL TRAINING, ONGOING MAINTENANCE, SERVICING AND SUPPLY OF CONSUMABLE PRODUCTS IS THE REPONSIBILITY OF THE RECEIVING ORGANISATION. DEFIBRILLATORS BEING OFFERED ARE A SINGLE USE PORTABLE DEVICE.
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