1.Please fill in your details below:

First Name & Last Name

Email Address

Phone Number

2.Please fill in your business or organisation details below:

Company Name

Your Position

Address

Address 2

City/Town

State

Postal Code

Country

ABN

3.What is your Business or Organisation size?

Micro-sized business: 1-4 employee/contractors

Small-sized business: 5 - 19 employee/contractors

Medium-sized business: 20 - 99 employee/contractors

Large-sized business: 100 and more employee/contractors

4.Is your business female owned or led (At least 50% female owned or led)

Yes

No

Other (please specify)

5.Is your business Indigenous Owned? (At least 50% owned by Aboriginal or  Torres Strait Island persons).

Yes

No

Other (please specify)

6.Is your business categorised in any of the following priority areas:

Advance Manufacturing

Aerospace

Agriculture and Food Research Development and Extension

Biofutures

Biomedical

Defence

OthHydrogen

Mining Equipment, technology and Services (METS)

Screen

Resource Recovery

Tourism

None of the above

please specify your industry sector:

7.Does your business include any of the below enabling technologies:

Artificial IntelligenceAugmented RealityBig DataBlock ChainCloud and Grid ComputingCrowdsourcingCybersecurityDisruptive TechnologyFinTech/e-commerceGamingGeospatial TechGIS ICT (Geographic Information System)Internet – BroadbandMobile TechnologiesPhotonicsPlatformTechQuantum ComputingIoT (Internet of Things)RoboticsSocial MediaVirtual RealityWirelessWi-Fi3DAgTechCleanTechDronesElectric VehiclesEnviroTechFoodTechMarine and Tidal PowerPhotovoltaicsRenewable EnergyRecyclingSmart CitiesSmart GridsWind TurbinesNanotechnologyBiochemicalsBioenergyBiofuelsBioplasticsBioproductsBiotechnologyBiologicsBiosecurityComplementary MedicineDiagnosticsGenomicsHealthTechMedical Products/devicesMedical TechnologiesImmunotherapyPharmaceuticalsStem Cells

8.From the list below, which business model innovation best describes your current need?

Investigate: I’m a new business wanting to explore various business model concepts

Build: I have an existing business and would like to expand our services or products

Transform: I have an existing business but would like to transform our current business model and explore new markets and industries

9.What do you see as the biggest opportunity available to your business over the next 3-5 years?

10.What do you see as the biggest challenges facing your business over the next 3-5 years?

11.Which three words or phrases describe your business mindset?

Motivated

Resilient

Open to new opportunities

A propensity for innovation

Creative

Flexible

Resourceful

Bold

Frustrated

Fear of Failing

Dont like to be challenged

I stick to what I know

12.What do you hope to achieve by attending this workshop?

13.We have a limit of 3 *people per business that can attend the workshop. Please list the names and positions of 2 other members of your team, or board, that will be attending, including yourself.

*Note this workshop is for women only.

14.Do you plan to apply for a travel and accommodation subsidy? 

Yes

No

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