DELEGATE/HSR REGISTRATION First name * Surname * Mobile Number * Union * Email Address Home Address Employer Site Name Site Address Site Phone Site Fax Site Type Site Type Apartments Bridges Factory Construction Site Roads Powerstations Site Estimated Completion Date Industry Sector Elected By Date Elected Organiser Rep Type Rep Type Delegate Only OHS Rep Only Delegate & OHS Rep Date Completed OHS Refresher Training Date Completed OHS Training 12 + 8 = Submit