"*" indicates required fields Step 1 of 3 33% Sustainable Winegrowing Australia (AWISSP) Certification Training (AWRI) - Monday, 11 December 2023Please ensure you enter the correct details for your business and that these correspond to the details registered for your Sustainable Winegrowing Australia membership. The details you enter in this form will be printed on your training certificate and registered with Freshcare. Please note, refunds are not provided. If you can no longer attend this event, please contact events@awri.com.au.Date: Monday, 11 December 2023 Time: 9:00AM - 4:30PM ACDT Venue: The Australian Wine Research Institute Location: Corner of Paratoo Road and Hartley Grove Urrbrae SA 5064Business trading name* Business legal name* ABN* Role*Please select the applicable optionSustainable Winegrowing Australia memberConsultant/ OtherCertification body representative/ AuditorTrainee name*The trainee should be the site owner/manager or suitably qualified person responsible for management decisions. First Last Phone/Mobile* Email* Dietary Requriements* None Lactose intolerant Gluten intolerant Vegetarian Vegan Kosher Other Street address of vineyard, winery or wine business* Street Address Address Line 2 Suburb State ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman 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 RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall 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 Mailing address is the same as above?* Yes No Mailing address* Street Address Address Line 2 Suburb State ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman 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 RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall 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 Member registrationThe information you supply in this form will be used to register your business with Freshcare Ltd for the purposes of certification against the Australian Wine Industry Standards of Sustainable Practice. FRESHCARE PRIVACY STATEMENT: The information being collected may be personal information. Freshcare Ltd takes its obligations under the Privacy Act 1988 (Cth) very seriously. The Freshcare Rules explain how and why information is collected, disclosed and published by Freshcare Ltd, in particular at clause 14. By providing the information contained in this form to Freshcare Ltd, you consent to Freshcare Ltd dealing with that information in the manner set out in the Freshcare Rules and the Freshcare Privacy Policy, both available online at www.freshcare.com.auSustainable Winegrowing Australia Membership number(s)*To qualify for registration as a member of Sustainable Winegrowing Australia, you must have completed the data, workbook and payment for the current year. Membership will be verified upon registration. Add RemoveTraining required*You are a wine business if you produce wine but do not have a physical vineyard or winery. Please select 'Wine Business'. Viticulture Winery Wine Business Additional training required*If you are a combined vineyard and winery/wine business please select the other from the list. To achieve certification of winery and viticulture, you must register both. If you do not require additional training, please just select 'Not required'. Not Required Winery Wine Business RegistrationThe information you supply in this form will be used to register your business with Freshcare Ltd for the purposes of certification against the Australian Wine Industry Standards of Sustainable Practice. FRESHCARE PRIVACY STATEMENT: The information being collected may be personal information. Freshcare Ltd takes its obligations under the Privacy Act 1988 (Cth) very seriously. The Freshcare Rules explain how and why information is collected, disclosed and published by Freshcare Ltd, in particular at clause 14. By providing the information contained in this form to Freshcare Ltd, you consent to Freshcare Ltd dealing with that information in the manner set out in the Freshcare Rules and the Freshcare Privacy Policy, both available online at www.freshcare.com.auTraining required*You are a wine business if you produce wine but do not have a physical vineyard or winery. Please select 'Wine Business'. Viticulture Winery Wine Business Additional training required*If you are a combined vineyard and winery/wine business please select the other from the list. To achieve certification of winery and viticulture, you must register both. If you do not require additional training, please just select 'Not required'. Not Required Winery Wine Business Additional attendeeFor in-person training, you may bring an additional attendee, please note that they will not receive a training certificate or have their training registered with Freshcare; therefore, cannot be the representative of the business at audit.Would you like to bring an additional attendee? Yes No Additional attendee name* First Last Dietary Requriements* None Lactose intolerant Gluten intolerant Vegetarian Vegan Kosher Other PaymentTotal All prices are GST (10%) inclusive.Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Δ
