Milparanga – Expression of interest

Milparanga Expression of Interest

For more information about the program, see see Milparanga - Developing Aboriginal and Torres Strait Islander Leadership.
1. Personal Details
Title*
Name*
First Last
Date of Birth*

Day
Month
Year

Must be 21 years or older
Gender*
Organisation*
2. Publicity
How did you hear about the program?*
Please specify
In 50 words or less describe your connection and interest in rural and regional Australia.*
3. Contact Details
Mobile Number*
Work Number
Email*
Address*
Address Line 1 Address Line 2 City State Postcode
Preferred method of communication*

We acknowledge the traditional custodians of all the lands on which we meet, work and live and recognise that this land has always been and always will be Aboriginal and Torres Strait Islander land.

Website
Facebook
Shoulder Tap
Word of Mouth
Conference
Internet Search
Other (please specify)

Milparanga – Expression of interest

Milparanga Expression of Interest

1. Personal Details

2. Publicity

3. Contact Details