APPLICATION

Executive Colloquium

16 - 21 July 2023, Melbourne

______________

COST $8,300 (Including GST)
*Enquire for NFP Rates

Your privacy matters. Cranlana Centre for Ethical Leadership does not share any of your details with any other external party. Neither do we blanket sell to you. The information we capture is for our own program use only to ensure smooth transition forward to your attendance at the event. (For details, please refer to the Privacy Policy and Terms & Conditions on our website).

Your application / registration will be reviewed and you will be contacted within two business days.

Please provide all information requested. Thank you for taking the time to provide this information.

Salutation

Example: Mr, Ms, Mrs, Miss, Dr, Prof etc.

First Name*

Last Name*

Post Nominals

Company Name (as to be used on a tax invoice raised).*

Position and Government Band/Level*

Department

Are you a Monash University Alumnus/Alumna?

If yes, please fill in your Monash ID

Board memberships (if applicable).

Why do you want to undertake this program?*

What are you expecting of the Colloquium week?*

How did you hear about Cranlana?*

Email*

Your EA's Name & Email (if applicable).

Your Office Phone Number*

Please include area code for landline numbers, for example 03 9902 4220.

Your Mobile Phone Number (please note we require this so we can advise of any last minute venue changes or program edits).*

Who do we contact in the case of an emergency whilst you are in attendance at the event? (Full Name, relationship to you and mobile phone number.)

Emergency Contact Name*

First Name

Last Name

Emergency Contact Phone*

Please include area code for landline numbers.

Emergency Contact Relationship

State of residence*

Please provide a detailed company postal address as required on your tax invoice (readings are not distributed until payment in full is received and incorrect invoice detail can delay payment).

Address Line 1

Address Line 2

City

State

Postcode

Who should we email your invoice to?

Other Email address for Invoice.

Your reading material is posted approximately 4 weeks prior to the event. Please provide an address to post your reading material to (if different to company address). Please consider the potential delay when using a government mail-room address.

Address Line 1

Address Line 2

City

State

Postcode

Do you have any special dietary requirements?*

Special dietary requirements

Do you have any special access (or other) needs?*

Special access (or other) needs

Monash University values the privacy of every individual's personal information and is committed to the protection of that information from unauthorised use and disclosure except where permitted by law. For information about the handling of your personal information, please refer to our Data Protection and Privacy Procedure and the Short Study Course Data Protection and Privacy Collection Statement (PDF).

If you have any questions about how Monash University is collecting and handling your personal information, please contact our Data Protection and Privacy Office at dataprotectionofficer@monash.edu.

By submitting, you agree to receive communications from the Cranlana Centre for Ethical Leadership, part of Monash University about your application for the Executive Colloquium program.*

Yes, I agree.

I agree to receive marketing communications from the Cranlana Centre for Ethical Leadership, part of Monash University. *

Yes, I agree. No, I disagree.