Tasmanian Leaders Inc

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Tasmanian Leaders Acceptance Form

TLP Program Acceptance Form

"*" indicates required fields

Your name

Name

Program Acceptance Questions

I hereby accept the offer by Tasmanian Leaders of a place on the 2023 Tasmanian Leaders Program.*
Program Dates*
Terms and Conditions*
www.tasmanianleaders.org.au/terms-and-conditions
Program fees*
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. As a participant of the 2023 Tasmanian Leaders Program, I will:
Participant Charter*
Participant Charter*
Participant Charter*
Participant Charter*
Participant Charter*
Participant Charter*
Participant Charter*

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

Preferred name, 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 ## #### ####

Details of secondary emergency contact

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

Employer contact details

Your organisations name
Manager name
The name of your direct manager who will be receiving your employer updates, as well as invites to networking events throughout the program.
Your managers email address for communications
Please provide full name of person (it might be yourself)
A current email address to receive the employer invoice

Medical, dietary, and accessibility

We want to ensure we are able to support your participation in the program

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.
The email address you received the form link from

A little bit more information

Photo

Please upload a recent photo (headshot), this will be used to share with participants at the start of your program
Max. file size: 64 MB.
A head and shoulders photo

Consent
Hidden
Hidden
Max. file size: 64 MB.
This card may be required for some venues, but is not essential.

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