Vision 21
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Registration North Qld Leadership 2019
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Phone Number
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Leadership programs attended
Vision21 is the association of past participants of Building Rural Leaders and similar programs. People who have completed a Vision21 accredited program may apply to be an Ordinary Member. Participants of other leadership programs may become an Associate Member at the discretion of the Management Committee. We welcome your application to join our vibrant network of leadership practitioners.
Program 1 - WHERE held?
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Program attended
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BRL Foundation (24 days)
BRL Advanced Program
BRL Tailored Program
Red Earth Community Leadership Prog (6-day)
Leading in the Central West (6 days)
Action Learning Facilitator
Other Program (6 - 24 days)
Guest Speaker
Program Presenter
Short program
Other
Year started?
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Program 2 - Where held?
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Other program attended
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BRL Foundation (24 days)
BRL Advanced Program
BRL Tailored Program (less than 24 days)
Red Earth Community Leadership Prog (6-day)
Leading in the Central West (6 days)
Other Program (6-24 days)
Action Learning Facilitator
Guest Speaker
Program Presenter
Short program
Other
Year started?
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V21 accredited Leadership programs
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BRL - all program types
RECLP - Red Earth Community Leadership Program (formerly South Burnett)
LCW - 6-day Leading in the Central West
Other - please give details
Accreditation of programs for Ordinary Membership is based on building a network of members who share similar concepts, principles, experience, and depth of learning. Select all that apply.
Describe other leadership development you've participated in, or that you have fostered!
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Associate programs
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ARLP - Australian Rural Leadership Program
Leadership programs less than 6 days long
Other program
We welcome people who've attended programs not yet accredited by Vision21, to participate in Vision21 as Associate Members, and be involved in many of our activities. Associate Members will not have voting rights. Select all items that apply.
Your signature
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If you are unable to insert an electronic signature, you may print this form, sign and mail it to: The Secretary, 23 Banksia Street, Boondall Q4034. If that is difficult, then just complete this form online and we will contact you for verification. Thank you.
Dated
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What do you hope to get from your Vision21 membership?
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Leadership news and inspiration
Participate in leadership-focused events
Further my leadership development
Practise and expand my leadership skills
Make a difference in regional communities
Stay in contact with program friends
Support for an Action Learning Set
To find an Action Learning Set
Individual or group coaching
Other - describe in box at right
Tick all that apply
What would you like to contribute to Vision21?
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Join the Management Committee
Lead a small action group
Help organise activities
Write a story for newsletter or social media
Provide feedback for our improvement
Be a quiet supporter
Other - describe in box at right
Tick all that apply
Describe Other - What you hope to get
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Describe Other - What you would contribute
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Comment - Reflections on your leadership experience and your development
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Vision 21 Incorporated IA18523 - ABN
31125363518 - has Broadform Liability Insurance to the value of $5m.
You will receive a message on your screen confirming the form has been submitted, however no automatic email is sent. However, we will contact you personally shortly.
Thanks for joining. We're excited to receive your application.
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