QWaLC Member Group – EVENT / ACTIVITY QUESTIONNAIRE "*" indicates required fields QWaLC Event IDOrganisation Name:* Name of the Event:* Description of Event/Activities:*Please provide brochure, flyer, etc.Max. file size: 10 MB.Link to Online Event Webpage or Social Media Event Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Start Date* DD slash MM slash YYYY End Date* DD slash MM slash YYYY Expected Number of Attendees:*Daily Hours of Operation:*Have you run this event before?* Yes No If Yes, how many attended last time this Event was held?*Are there vendors stalls at the event?* Yes No How many Stalls are at the Event?*Do all vendors/exhibitors, contractors, food providers, amusement operators, performers carry their own liability insurance?* Yes No If Yes, copies of policies and/or certificates of currency must be provided to QWaLC by emailAre you noted as Principal on the above vendors, etc insurance?* No Yes Are attendees allowed to bring alcohol to the event?* No Yes Will alcohol be sold at the event?* No Yes Name Liquor License is in: Specify Class of License: Has the Liquor License ever been suspended or revoked No Yes If Yes, please explain why?Number of Days Selling Alcohol:*Alcohol is available from* Hours : Minutes AM PM AM/PM Until* Hours : Minutes AM PM AM/PM Are attendees allowed to bring alcohol to your event?* No Yes Are under aged people at the event?* Yes No Are alcohol sales restricted to a confined space?* Yes No Are appropriate “responsible” servers of alcohol notices displayed?* Yes No Are volunteers/staff trained in responsible service of alcohol?* Yes No Will there be entertainment at the event?* Yes No (e.g. opera, jazz, rock, theatre, stilt walkers, etc?)Please list all of the types of entertainment below* Add Remove(click the + sign to the right of a row to add more)Do performers hold your organisation responsible for injuries suffered?* No Yes (If Yes, please provide copy of contract)Upload copy of contract*Max. file size: 64 MB.Is there any security at the event?* Yes No Where is security provided? Internal External If Yes, do they hold their own Liability insurance? Yes No Is there medical personnel at the event?* Yes No List*TypeQualificationsTotal of this type of personnel Add Remove(click the + sign to the right of a row to add more)Authorised Person* First Name Last Name Position* Phone*Email* Declaration and SubmissionBy clicking the 'Submit Event Details' button below: As the authorised person you declare that the details and information provided by you in this questionnaire are: (i) true and correct and as a result (ii) you understand that the details of your event will recorded by QWaLC, and may be used in the event of an insurance claim being made by you or any ofthe attendees, stall holders, performers, you staff and volunteers. Thank you for taking the time to complete this questionnaire...
