Building Rural Leaders
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Registration North Qld Leadership 2019
Registering - North Queensland Leadership programs winter 2019
decision to apply for one of our North Queensland Community Leadership Programs.
The information you provide here will be kept confidential and will assist us in designing a high quality program for our participants.
In winter 2019 our 3-day community leadership program will be held in two regions. Use this registration form to apply to attend either:
Leading the Dry Tropics
17-19 July 2019, held in Bowen
Leading the Wet Tropics
14-16 August 2019, held in Innisfail
Indicates required field
Which program are you applying to attend?
Leading the Dry Tropics: 17-19 July 2019 (Bowen)
Leading the Wet Tropics: 14-16 August 2019 (Innisfail)
I understand that this program is heavily subsidised and commit to attending the full program
I'm not sure
Name (Given - Family)
Work or Volunteering Organisations
Please tell us the organisation you are representing at the program, and if not representing an organisation, just write 'individual'.
Phone - preferred
Phone - other
EMERGENCY CONTACT - Name
information for selection panel
What do you hope to gain from this program/ why are you interested?
What does 'leadership' mean to you?
How did you hear about this program?
commitment to program and cancellation
I am committed to attending the three day program, which may include night time participation and, as a participant, to actively contributing in order to make this program a success.
I understand I am responsible for organising my own accommodation and travel to and from program activities.
I understand that if I am accepted into the program, and cancel within two weeks of program commencement, all fees paid will be forfeited unless a replacement participant can be found to take my place.
I agree to attend the full 3-day face-to-face module and a post-program teleconference 6 weeks after that module.
The organisers and sponsors would like to support those people who will benefit from this program but may have difficulty meeting the financial costs. Limited scholarships are available to ensure that financial concerns are not a barrier to participation. Please indicate in your application if you are requesting a scholarship.
The fee to complete this course is $1200 with no GST payable, as Vision21 is a community organisation, not registered for GST. Vision21 acknowledges the financial contribution of the Gaming Community Benefit Fund which provides considerable financial assistance to fund the two North Queensland programs in Winter 2019.
A tax invoice will be provided to you upon successful application for this course.
All personal information collected to facilitate this application is confidential and will not be disclosed
to any external party unless required to do so by law. Where available, some sponsors require basic data (Name, Date of Birth, Postcode) to enable them to provide sponsorship to the program.
I am able to contribute the following to attend the leadership program
I will be paying the full amount of $1200
I wish to apply for scholarship of $1000 and am able to contribute $200 towards costs
Amount to pay $
There are limited places in this program. We are seeking applicants from a broad range of backgrounds and ages with a diverse range of life experiences. Your answers to the application questions will help with the selection process. You do not need to be currently involved in community or industry initiatives. We believe that people seeking to improve their skills and knowledge is a valid reason for attending either of the North Queensland Community Leadership Programs -
Leading the Dry Tropics
Leading the Wet Tropics.
Participants in the programs, including scholarship recipients, will be selected via a shortlisting process based on the eligibility criteria and response to the questions above. The selection panel will include representatives of past leadership programs and your regional community.
Leading the Dry Tropics - Bowen
Closing date for applications is Friday 28 June 2019
Successful applicants will be notified by Friday 5 July 2019 at which time full program details will be provided.
Leading the Wet Tropics - Innisfail
Closing date for applications is Friday 26 July 2019 (later applications may be received if vacancies available). Successful applicants will be notified by Friday 2 August 2019 at which time full program details will be provided.
Late applications may be received if vacancies available.
If cancellation is advised within two weeks prior to program commencement, you will receive a full refund only if a replacement participant can be found to take your place. If no replacement can be found, all fees will be forfeited. Cancellation after commencement of the program will forfeit all fees.
Please indicate your acceptance of these conditions
I accept the terms of the cancellation policy
If you require assistance to complete this application, contact Heather Ellis, Deb Atkins or Pamela McAllister.
CONTACT vision 21
Phone Heather Ellis
Phone Pam McAllister
Phone Deb Atkins
0427 639 848
0400 507 390
0415 135 457
Comments, questions or suggestions
EFT PAYMENT DETAILS:
Suncorp Bank: BSB 484-799
Account Number 452679531
Account Name: Vision 21
REFERENCE: First and last name
If, on clicking '
', you do not receive an acknowledgement message, check to see there are no red boxes indicating more information is needed on your registration.
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