National Seafood Industry Leadership Program 2021

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 National Seafood Industry Leadership Program 2021?*

What is your vision for the seafood industry/community?*

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.*

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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.*

In registering for the National Seafood Industry Leadership Program, I understand that I will be responsible for the payment of a participant fee of $990 (GST inclusive) prior to commencement of the program. I will also be responsible for travel, accommodation and sundry costs.*

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.*

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NATIONAL SEAFOOD INDUSTRY LEADERSHIP PROGRAM

2021 APPLICATION FORM

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