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I-LEAD Pride promotional image., A blurred image of rainbow flag bunting stretching from the top left to middle right area of an outdoor scene

I-LEAD Pride Program Acceptance

I-LEAD Pride Program Acceptance

"*" indicates required fields

Your details for our participant handbook

Legal Name*
Preferred Name*
eg She / her, He / him, They / their, He / they, She / they
Preferred phone number for program communication
Preferred email for program communication

Let us know what details you would like on your name badge

Preferred name, pronouns, role, and the company you are representing
e.g. Ange Driver instead of Angela Driver
e.g. CEO
e.g. Tasmanian Leaders Inc.

Details of primary emergency contact

Full name
Husband, wife, partner, parent, brother, sister, etc.
#### ### ### or landline ## #### ####
#### ### ### or landline ## #### ####

Reasonable adjustments and support

Do you have any dietary requirements, allergies or medical conditions?
Do you require any reasonable adjustments or other support to enable you to participate fully in the program?

A little bit more information about you

Please submit a short 100-150 word bio about yourself that we will share with fellow participants. NOTE: Please write your bio in the third person
Please upload a headshot that we can include with your bio. Preferred formats are jpeg, png or svg. We prefer a full colour, squared image, with plenty of space around your head and shoulders
Max. file size: 64 MB.

Program Acceptance Questions

Participation*
I will undertake to attend all program sessions as outlined in my letter of offer. I understand that full benefit from the program can only be gained by full attendance and I acknowledge the expectation that participants will only be absent from program sessions in exceptional circumstances and any absence greater than 20% will impact my abilty to graduate. In the unlikely event that such circumstances arise, I understand this may impact my eligibility to graduate from the program.
Participant charter*
I-LEAD participant charter*
I-LEAD participant charter*
I-LEAD participant charter*
Access Bursary acknowledgement*
I acknowledge that if I have received an access bursary, I will: 1) Complete a bursary acquittal declariing I have spent the funds in line with their intended purpose. 2) If I do not complete the program, I may need to repay the bursary.

Your Privacy and Consent

Terms and Conditions*
https://www.tasmanianleaders.org.au/i-lead-terms-and-conditions/
Consent*
Once you have reviewed the Terms and Condistions, please select from the below options to confirm your consent for us to share information, whilst ensuring your privacy is maintained.

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