Expression of Interest: CONNECT Regional Innovation Hubs Complete the expression of interest form and be contacted directly when CONNECT applications open. Question Title * 1. Full name Question Title * 2. Email address Question Title * 3. Company name Question Title * 4. In what town and postcode is the company based? Question Title * 5. If you have staff, how many staff are in Western Australia? 1-5 6-10 11-20 >20 Question Title * 6. If you have a Company website then list it here Question Title * 7. What market does your business sell to?(please select only 1 or 2) Mining Energy Agriculture Medical Transport Retail Tourism Education Government Other (please specify) Question Title * 8. Please indicate how you heard about the CONNECT program Done