Online Application Form

Online Application Form

Applications may be submitted up to 5.00pm WAST on Monday 31 May 2010.

  1. Please complete all fields marked *
PERSONAL DETAILS
PERSONAL INTRODUCTION
SUMMIT STATEMENT
TRANSPORT OPTIONS
  1. Monday 26 July 2010

    (departures scheduled from Broome at intervals from 6.00am)

  3. Friday 30 July 2010

    (departures scheduled from Billard at intervals from 9.30am)

OTHER REQUIRED INFORMATION
  1. DIET
  4. MEDICAL
  7. BODY WEIGHT
  8. For meeting payload requirements on air charter/s (please complete even if air charter is not your preferred mode of travel, in case of evacuation)
  10. T-SHIRT SIZE
PAYMENT ARRANGEMENTS
  2. Please note that Billard Aboriginal Corporation:
    • 1. does not accept payment by credit card;
    • 2. cannot manage late payments; and
    • 3. registration unpaid after 30 days will lapse

  3. Please provide the contact details for processing of the Tax Invoice (it will be forwarded to you with your invitation for payment within 30 days)

  6. *Indigenous applicants seeking sponsorship, go to Sponsorship Information
SPONSORSHIP INFORMATION
  2. Please provide a supporting referee who can comment on your application for sponsorship - someone who knows you well and who you are happy for Billard Learning Centre to ask about your application for sponsorship
SUMMIT COMMITMENT
  1. In applying for the Blank Page Summit Hard Yarn, I agree to:
    1. arrive in Broome no later than the evening of Sunday 25 July 2010
    2. attend the Blank Page Summit for the full schedule of activities (Monday to Friday)
    3. join and contribute to a Blank Page Summit Working Group
    4. act in good faith in relation to the purpose and principles of the Blank Page Summit
    5. co-operate with physical arrangements at the Summit site to assist smooth running
COPY OF APPLICATION FORM
 

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