Concourse Dance Bar

Organization name(Required)

Registered address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Organization type(Required)

Website(Required)

Telephone number(Required)

Country Phone Number

Ownership structure(Required)

Independently owned

Hospitality chain

Franchise

Other

Parent company name(Required)

License type

Licensing authority

Primary contact name(Required)

First Last

Primary contact email(Required)

Primary contact telephone(Required)

Country Phone Number

Responsible signatory (owner or general manager)(Required)

Authorization(Required)

I am authorized to submit this application on behalf of the venue.

Voluntary participation(Required)

I acknowledge that participation in the Serving with CARE initiative is voluntary.

Commitment(Required)

I confirm that our venue commits to adopting and embedding the Serving with CARE Principles into our daily operations and staff culture.

Term(Required)

I understand that my commitment extends to the next 12 months, after which I will be prompted to reconfirm my commitment.

Brand assets(Required)

I agree to use the program name and brand assets in line with the guidelines.

Accuracy(Required)

I confirm that the information provided in this application is accurate and complete to the best of my knowledge.

Name of signatory(Required)

Role(Required)

Date(Required)

Signature(Required)

Type your full name to sign this application electronically.