Expression of Interest

Welcome!

Thank-you for taking the time to complete this Expression of Interest form regarding the People Focused Leadership workshop.
You can find information about this, and other workshops, by visiting www.healingphase.com.au.

Please carefully read and complete the relevant sections of this form. 
Rest assured the information you provide will remain confidential.
I will respond to your submission of this form within 2 business days, with an email or text message offering some days and times to speak via phone (in line with your indicated availability).

I am looking forward to connecting with you, answering any questions you may have, and hopefully working together soon.
Wishing you all the best.
 
Warmest regards.
Nick Valentine

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* 1. Date 

Date

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* 2. Are you submitting an expression of interest on behalf of you (i.e., personal), your team / employer, or both?

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* 3. Full Name

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* 4. Gender Identity

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* 5. Culture

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* 6. Are you of Aboriginal or Torres Straight Island origin?

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* 7. Date of Birth

Date

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* 8. Relevant Address (Personal or Business)

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* 9. Relevant Phone (Personal or Business)

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* 10. Preferred Contact

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* 11. Employer

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* 12. Occupation

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* 13. Role / Title

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* 14. How did you hear about my services?

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* 15. Have you or your employer ever participated in a workshop by Healing Phase in the past?

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* 16. What is the best time to contact you?

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* 17. Please list any questions you have, or anything else that you want me to know, in preparation for our future contact

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* 18. By selecting 'agree' below, you are indicating that you have answered the relevant questions on this form and agree to be contacted

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