EXT014 ACA Medical Service Provider Confirmation

Page 1


Australian Campdraft Association Inc.

Medical Services Provider Confirmation Form

that our organisation:

Has read and understands the Medical Services Policy, Version 2.01, and

In providing services to ACA and it’s affiliated committees, meets ACA’s minimum requirements as set out in the COR017 Medical Services Policy, Version 2.01.

This form is valid until the end of the ACA Financial Season (being 31 December each year), in which it is signed.

Signed:

Name: ..............................................................................

Position: ..............................................................................

Company: ..............................................................................

Date: Organisation Name

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