Paid participation form:

Please fill out one form for each day of activity. If you participated in activities on different days you will need to fill out a form for each of those days.

Instructions are available here. For Collaborative and Network members, please find relevant instructions available here.

I am an individual, this supply is of a private nature and no ABN needs to be supplied.

Participant details

Full name

Email address

Activity date

Activity description

COORDINARE / Suicide Prevention Collaborative contact name

Banking details

I have already submitted my banking details.

Bank

BSB (XXX-YYY)

Account number

I confirm that information in this form is correct and consent for my information to be shared with COORDINARE to process my payment.

Activity claim

Activity rate

Daily rate (5+ hours) - $455.25

Part day rate (4 hours or less) Hourly rate: $91.05 (rounded up or down to the nearest half hour)

Hourly rate - $91.05 (where above options do not apply) - with COORDINARE's consent*

None

Note: if you only want to claim out-of-pocket expenses, just select "None".

Expenses

Out-of-pocket expenses E.g. meals, taxis and parking. This will be reimbursed on top of the activity fee.

Use of personal motor vehicle

Please enter kilometres travelled

Date of Journey		Purpose of Journey	Odometer		KM Travelled
Start	End	Purpose of Journey	Start	End	Business	Private

Total paid participation to be paid upon approval

This is the sum of activity fee, out-of-pocket expenses, and travel costs.