Tasmanian Leaders Acceptance Form

Your name

Name

First Last

Program Acceptance Questions

I hereby accept the offer by Tasmanian Leaders of a place on the 2025 Tasmanian Leaders Program.*

Yes

Program Dates*

I agree to attend the sessions as detailed in the program offer I received

Terms and Conditions*

I agree to adhere to and remain bound by the Terms and Conditions set forth by Tasmanian Leaders, subject to potential amendments. I understand that these terms impose obligations on me and, among other things, limit any liability Tasmanian Leaders may have otherwise had towards me.

www.tasmanianleaders.org.au/terms-and-conditions

Program fees*

I understand that by submitting this form and accepting a place on the 2025 Tasmanian Leaders Program I am committing to paying the participant contribution of $1,430.00, noting the non-refundable deposit of $500 is due by Monday 9 December.

www.tasmanianleaders.org.au/terms-and-conditions

Participant Charter

In accepting an offer to undertake the Tasmanian Leaders Program (TLP), you acknowledge the following undertakings.

Participant Charter*

Code of Conduct: I will uphold the behavioural standards expected by the program and Tasmanian Leaders, serving as an ambassador for both. This includes treating my program peers, speakers and other guests with respect and professionalism always.

Participant Charter*

Attendance: I understand the importance of attendance and commit to attending all program days and associated events. In case of exceptional circumstances, I will communicate with program authorities.

Participant Charter*

Engagement: I will fully engage in all program activities, including surveys, pre- and post-work, and reflections, and complete them thoughtfully within the given timeframes. I will also work collaboratively with my fellow participants to plan and carry out any assigned group work, and for the Tasmanian Leaders Program commit to delivering a project as part of a Learning Set.

Participant Charter*

Ongoing Leadership: I will actively participate in leadership initiatives beyond program participation to support and promote a positive future for Tasmania, regardless of my location.

Participant Charter*

Graduate Search: I will register my skills and interests with Tasmanian Leaders, and I am open to collaborating with fellow graduates or responding to inquiries from the public through the Tasmanian Leaders Graduate Search. I will ensure my contact details are up to date to enable this.

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

Preferred name, role, and the company you are representing

Preferred name*

e.g. Ange Driver instead of Angela Driver

Role*

e.g. CEO

Company you are representing*

e.g. Tasmanian Leaders Inc.

Details of primary emergency contact

Name*

Full name

Relationship to you*

Husband, wife, partner, parent, brother, sister, etc.

Phone (primary)*

#### ### ### or landline ## #### ####

Phone (secondary)

#### ### ### or landline ## #### ####

Would you like this person to make requests on your behalf?*

Details of secondary emergency contact

Name

Full name

Relationship to you

Husband, wife, partner, parent, brother, sister, etc.

Phone (primary)

#### ### ### or landline ## #### ####

Phone (secondary)

#### ### ### or landline ## #### ####

Would you like this person to make requests on your behalf?

Employer contact details

Employer*

Your organisations name

Manager name

First Last

The name of your direct manager who will be receiving your employer updates, as well as invites to networking events throughout the program.

Managers email*

Your managers email address for communications

Please send my employer invoice to*

Please provide full name of person (it might be yourself)

Employer invoice email*

A current email address to receive the employer invoice

Medical, dietary, and accessibility

Do you have any special dietary requirements?

Nut allergy

Egg allergy

Coeliac

Gluten free

Vegetarian

Pescatarian

Vegan

Dairy free

Other

If you selected other, please specify details below*

If your dietary requirement is an allergy, please provide more detail*

e.g., do you carry an Epipen? Are traces of this food type a problem? Do you have an allergy emergency plan?

Do you have any medical conditions, allergies we should be aware of?*

(e.g., allergies to specific medications, insect bites etc or any other health conditions that may impact your participation)

Do you have any accessibility needs or accommodations that would help you fully participate in the program?*

(e.g., mobility assistance, assistive devices, preferred room arrangements)

Do you actively practice a religion or faith?

Yes

Section Break

If so, please specify any requirements or accommodations we should be aware of?*

(e.g., prayer times, religious observances)

Do you have any specific requests for your Residential accommodation requirements?*

(e.g., very tall, pregnant etc)

Communicate and share information during the program

To enable us to communicate and share documents with you during your program experience, we will be establishing a Microsoft Teams account. To help set this up, please confirm the email you would like the account invitation to be sent to? This email will be used for logins and notifications. If you already have a Microsoft Teams account you might like to use the same email address.

Mobile Phone Number*

Please supply the primary email address you used to apply to the program*

The email address you received the form link from

Would you like to use the same email address for Microsoft Teams?*

If no, please supply an alternate email address*

A little bit more information

Bio*

Please submit a short 100-150 word bio about your career that we will share with your program peers.

Photo

Please upload a recent photo (headshot), this will be used to share with participants at the start of your program

Participant photo*

Accepted file types: jpg, png, pdf, Max. file size: 64 MB.

A head and shoulders photo

Consent

I give consent to Tasmanian Leaders to share my mobile number and email with my fellow participants

This field is hidden when viewing the form

I have received all required Covid-19 vaccinations

This field is hidden when viewing the form

Covid-19 digital certificate

Accepted file types: jpg, png, pdf, Max. file size: 64 MB.

I have a current Working with vulnerable people's card*

This card may be required for some venues, but is not essential.

WWVP card number*

WWVP expiry date*

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TLP Program Acceptance Form

Your name

Program Acceptance Questions

Participant Charter

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

Details of primary emergency contact

Details of secondary emergency contact

Employer contact details

Medical, dietary, and accessibility

Section Break

Communicate and share information during the program

A little bit more information

Photo