DISASTER RECOVERY REGISTRATION FORM

Please fill out the form below to register.

Name of Applicant:
Address for Contact:

Postcode:
Telephone Number:
Fax Number:
E-Mail:
Number of sites to be covered by this regestration:
Collections to be covered by Scheme:
Address of site/s if different from above:

Do you currently have an active Disaster Control Plan/Manual or policy document?

Yes: No:
If yes, have you included a copy of your Plan With Registration Application Form?

Yes: No:
If no, are you compiling one in the next 12 months and want to include Riley Dunn & Wilson as one of your Disaster Recovery Agents?

 Yes: No:
Do you have up-to-date Disaster Equipment and Materials in boxes, trolleys or store?

 Yes: No:
Are you wiling to affirm once a year that your Institution is still eligable to be a Scheme Member? Yes: No:

Who are your named contacts for our Regestration Office to hold on file?

 
First Contact Name:
Position:
Second Contact Name:
Position:
Address:



Postcode:
Telephone Number:
Fax Number:
Which insurance company, if any, provides indemnity cover for the collections in the event of any Disaster?
Do you agree to reimburse Riley Dunn & Wilson Ltd. for the invoiced cost of staff, time, travel, subsistence, transport, and freezer storage space if these are incurred?
Do you agree to keep the Registration Office informed of any significant changes to the information? (e.g. contact names, personnel, addresses, contact telephone numbers)
Name :
Date:
Position:
Invoice address if different from above:
Order Number: