2023 Online National Seafood Industry Leadership Program – Application Form - affectus

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2023 ONLINE

NATIONAL SEAFOOD INDUSTRY LEADERSHIP PROGRAMs

APPLICATION FORM

Applications Closing Date

COB 24 April 2023

Name*
First Last
Preferred Name*
First
Address - Street Name and Number OR PO Box
City/Town*
Postcode*
State*
Email*
Mobile*
Work Phone*
Facebook Name and URL*
Linkedin Name and URL
Twitter and/or Instagram
Current Employer/Business Name*
Applicants current workplace position/Job Title*
Invoicing Information - Read the information below.*
If you are accepted into the National Seafood Industry Leadership Program we will invoice for the Participant Fee. You must include the following information for Affectus to generate and send a Tax Invoice:1. For a Business Invoice * Business Name; * ABN; * Contact Person for Invoicing - Name, Email and Phone No.2. For Individual Invoicing * Name of the Person for Invoicing *Email *Phone No.
How did you hear about the National Seafood Industry Leadership Program?*
Have you applied for the National Seafood Industry Leadership Program before?*
To which sector of the Australian seafood/fishing industry/community do you belong?*
How long have you been involved in the seafood/fishing industry/community?*
Do you have any relevant training/qualifications? (eg Cert. Business Management, Certificate III in Fishing Operations)?*
Outline any leadership training you have had?*
What have been your major achievements - within or beyond the seafood industry / community?*
What current roles and/or responsibilities do you hold in the seafood/fishing industry or your community?*
Why are you applying for the 2023 Online National Seafood Industry Leadership Program?*
What is your vision for the seafood industry/community?*
No more than 30 words
During the National Seafood Industry Leadership Program, participants undertake a group industry “mission” (like a project). Tell us how YOU will work with other participants to ensure the Mission is delivered to the industry by the end of the program?*
No more than 30 words.
Endorser Name - We request that you seek someone who knows you and is willing to endorse your nomination. We will contact them about their endorsement. Please provide us with your endorsers details.*
First Last
Endorser Organisation/Business/Company*
Endorser Address*
Endorser City/Town*
Endorser State*
Endorser Postcode*
Endorser Email*
Endorser Mobile*
My endorser has agreed to endorse my application to the National Seafood Industry Leadership Program.*
By registering for the 2023 Online National Seafood Industry Leadership Program, I understand that I will be responsible for the payment of a participant fee of $660 (GST Ex) prior to commencement of the program. I will also be responsible for telecommunication, printing and incidental.*
Consent - By entering your name in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate to the best of your knowledge and that you are consenting that the information provided can be used for the purpose of National Seafood Industry Leadership Program participant selection and other activities connected to the National Seafood Industry Leadership Program.*
Name
This field is for validation purposes and should be left unchanged.

Applications Closing Date

COB 24 April 2023