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AVERT Registration Application

Home > Forms > AVERT Registration Application

AVERT Registration Form

Step 1 of 5

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Occupation
Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Vet Registration Number*
Enter your vet registration number
State
State

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Licences
Please select valid licences
- Drivers
- Darting
- Shooters
- Other
Other Licences
Vaccinations (up to date)
Please select your up to date vaccinations
- Tetanus
- Rabies
- Other
Other Vaccinations
Authorised officer (Govt.)
- Biosecurity Act
- Export Control Act

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Training
Tell us a bit about your training
Training courses undertaken
- Biosecurity – including use of personal protective equipment, entry and exit procedures, decontamination and the importance of following correct procedures
- Contemporary emergency management arrangements and structures, including arrangements for management of natural disasters and emergency animal diseases
- Emergency services agencies – e.g. AIIMS (Australasian Inter-service Incident Management System) training
- Information management, information flow and communications in a response (including privacy/confidentiality/reporting lines, records management)
- RFS, CFA, SES, Other State based emergency services training
- Stress management
- Other training courses not specified
Please list other training*

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Experience
Do you have experience working in disasters*
- Yes
- No
Please list your experience working in disasters
Do you have an understanding of where vets (whether volunteers or employed) fit within the response to incidents (including the concepts of lead agency and support agencies)*
Please select your field of expertise*
You may select more than one.
- Small animal
- Large animal
- Equine
- Wildlife and exotic animals
Number of years working in your selected field*
Other areas of special interest or experience
Any other information/experience you have that would be of assistance in emergency situations in Australia or Overseas
In emergency situations, where would you be available to work?*
- In the field
- Off-site eg: Triage Clinic
- In a control centre
Consent*
I agree
I AUTHORISE VETS BEYOND BORDERS TO RELEASE MY INFORMATION TO EMERGENCY RESPONSE OFFICIALS IN THE EVENT OF AN AVERT EMERGENCY SITUATION
Signature*
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