IMPACT Centre - 2019 Professional Network Registration Form Survey

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* This is an old survey! It is not being monitored.

Click here to register via the new survey!

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* Participant Details

School Name

First Name

Last Name

Job Title/Position

Phone Number

Dietary Requirements

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* Aspiring Thinkers
Contact: Glen Watt - gwatt5@eq.edu.au

Foundational Workshop 1
Dates: 21/02/19 - 22/02/19
Venue: University of Queensland, St Lucia, Brisbane

Foundational Workshop 2
Dates: 28/02/19 - 01/03/19
Venue: University of Queensland, St Lucia, Brisbane

Foundational Workshop 3
Dates: 14/03/19 - 15/03/19
Venue: Townsville - venue TBA

Foundational Workshop 4
Dates: 02/05/19 - 03/05/19
Venue: University of Queensland, St Lucia, Brisbane

Foundational Workshop 5
Dates: 23/05/19 - 24/05/19
Venue: Regional location - TBA

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* Aspiring STEM Specialists
Contact: Katie Ellard - kella2@eq.edu.au

Foundational Workshop 1
Dates: 28/02/19 - 01/03/19
Venue: University of Queensland, St Lucia, Brisbane

Foundational Workshop 2
Dates: 14/03/19 - 15/03/19
Venue: Rockhampton - venue TBA

Foundational Workshop 3
Dates: 23/05/19 - 24/05/19
Venue: University of Queensland, St Lucia, Brisbane

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* IMPACT Innovators
Contact: Kevin Connell - kwcon0@eq.edu.au

Foundational Workshop 1
Dates: 07/03/19 - 08/03/19
Venue: University of Queensland, St Lucia, Brisbane

Foundational Workshop 2
Dates: 02/05/19 - 03/05/19
Venue: University of Queensland, St Lucia, Brisbane

Foundational Workshop 3
Dates: 23/05/19 - 24/05/19
Venue: Regional location - TBA

Question Title

* Briefly explain your reasons for joining the selected network/s.
You might explain your school's aims, your role in this, your own aims, what you plan to achieve etc.

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* Additional information (optional)

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* Terms & Conditions

I have approval from my relevant school/department/system leader to register for the professional network/s selected.

I acknowledge that my school will be invoiced a membership fee of $950 per person by the IMPACT Centre after the foundational two-day workshop and that this membership is valid for 12 months.

Click the Submit Registration button below to finish this registration.

Question Title

* This is an old survey! It is not being monitored. Click here to register via the new survey!

Question Title

* Participant Details

Question Title

* Aspiring Thinkers Contact: Glen Watt - gwatt5@eq.edu.au

Question Title

* Aspiring STEM Specialists Contact: Katie Ellard - kella2@eq.edu.au

Question Title

* IMPACT InnovatorsContact: Kevin Connell - kwcon0@eq.edu.au

Question Title

* Briefly explain your reasons for joining the selected network/s.You might explain your school's aims, your role in this, your own aims, what you plan to achieve etc.

Question Title

* Additional information (optional)

Question Title

* Terms & Conditions

* This is an old survey! It is not being monitored.

Click here to register via the new survey!

* Aspiring Thinkers
Contact: Glen Watt - gwatt5@eq.edu.au

* Aspiring STEM Specialists
Contact: Katie Ellard - kella2@eq.edu.au

* IMPACT Innovators
Contact: Kevin Connell - kwcon0@eq.edu.au

* Briefly explain your reasons for joining the selected network/s.
You might explain your school's aims, your role in this, your own aims, what you plan to achieve etc.