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Provider Registration
Step
1
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2
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Let's set you up a promoter account
Name of Organisation
*
Organisation Website Address
Are you an NDIS provider?
*
Yes
No
Organisation Address
*
Street address 1
Street address 2 (optional)
Suburb
State
VIC
NSW
ACT
QLD
SA
NT
WA
TAS
Post Code
Phone
*
Email
*
This will be used for your login.
Password
*
Your password must be at least 8 characters and contain a minimum of 1 lower case letter [a-z], 1 upper case letter [A-Z], 1 numeric character [0-9] and 1 special character: ~`!@#$%^&*()-_+={}[]|\;:"<>,./?
Password
Repeat Password
Strength indicator
Who's your key contact?
Your details will not be published.
Name
*
First name
Last name
Contact Position
Contact Phone
*
Contact Mobile
Contact Email
*
Phone
This field is for validation purposes and should be left unchanged.
