Leadership Learning Intensive Registration Survey Please complete this survey to express interest in Plan to Win's Leadership Learning Intensive. The aim is to gather the group by the end of 2018 so we'll be in touch soon. If you have any queries get in touch with Holly Hammond: holly@plantowin.net.au Question Title * 1. Please let us know your contact info for follow up. Name: Organisation/Group: State: Email Address: Phone Number: Question Title * 2. What interests you in this opportunity? Question Title * 3. What is a current challenge you are experiencing in your social change work that you would consider bringing to this group? (The actual challenges you explore can change over the program, this is to get a sense of your needs) Question Title * 4. The aim of this program is to increase the effectiveness and resilience of social change leaders, leading to positive ripples through your organisation/campaign/movement/community. Please give us a sense of your role and work (paid or unpaid) and how investing in your leadership may impact on others. Question Title * 5. Workshop preferenceFor the initial one day training please indicate which of these you are available for. If you are available for both dates but have a preference for one over the other let us know in the comments. Friday 1 February Saturday 2 February Neither, please contact me about other options Let us know about your preferences. Question Title * 6. Monthly session preferencePlease rank in order of preference the following option for the program's monthly 2 hour long sessions. 1 2 3 4 5 Week day day time 1 2 3 4 5 Week day evening 1 2 3 4 5 Saturday day time 1 2 3 4 5 Sunday day time 1 2 3 4 5 Sunday evening Question Title * 7. DiversityPlease tick as many identities/backgrounds as apply to you. This question is to help us gather a diverse and inclusive group but not finding yourself in this list doesn't mean you won't be welcome. Aboriginal or Torres Strait Islander Person of colour Culturally and linguistically diverse Working class LGBTIQ+ Trans*, intersex, nonbinary or other gender identity Parent Carer Person with a disability Other (please specify) Question Title * 8. FeesFees are on a sliding scale of $400-$1200 per person for the full course ie $400 for low income individuals/unfunded organisations; $800 for average waged individuals/medium sized organisations; $1200 for well waged individuals/larger organisations with a solid financial base; or points along this scale. Payment in instalments is welcome. We will issue an invoice for your fee or be in touch to discuss options. I will pay the following fee (include amount in the box below) I'd like a Pay the Rent space (free attendance for Aboriginal and Torres Strait Islander participants) Money is a barrier to me attending - please contact me to discuss options I'd like to donate to support attendance by low income activists (include amount in the box below) Fee and donation details Question Title * 9. Is there anything else you would like to add or ask? Please include any accessibility issues we should be aware of. Thanks for your input! We'll be in touch to confirm your registration soon. No payment needed at this stage, we'll send you an invoice. Done
