Emerging Leaders 2024 Registration Form

PO Box 238 Hillarys WA 6923 info@outbackin.com.au
2024 Emerging Leaders Program Registration Form

30 September - 4 October 2024
Experience 5 challenging and rewarding days in the stunning Southwest region of WA, in an immersive learning experience.

Through personal development coaching and consequence-based team activities, you will gain an understanding of who you are, what has held you back, and how to leverage your strengths to achieve your goals. There's no greater value than a leadership development program that accelerates your self-awareness, expands your network and provides practical and sustainable leadership skills that can be utilised immediately.

Investment is $3,999 ex GST.

Nominations close 1 September 2024. There is a $250 non-refundable deposit on booking. Invoices and receipts are provided.

Should Covid conditions affect the program through closures, we will hold the deposit/booking for the next program or it can be transferred to another program.

Places are strictly limited.

Inclusions: While on the program all meals, transport, accommodation, activities; DISC profile assessment; leadership course book; post-program workshop session.

Investment is fully tax deductible for employed or self-employed participants.
PARTICIPANT DETAILS
Your Name*

First NameLast Name
Organisation (if applicable):
Your E-mail*
Your Phone Number*

Area CodePhone Number
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
INVOICING DETAILS
Organisation/Payee*
Is this organisation a Not For Profit?*

YesNo
E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

My Products*

2024 Emerging Leaders non-refundable deposit$250.00AUD

Enter coupon

Total $0.00AUD

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Once we have your deposit, we will issue a receipt and an invoice for the balance to be paid in full at least 8 weeks prior to program commencement.

We will send the next steps via email to you which include joining instructions (including where to go, when to be there and what to bring) and a link to request your medical information and DISC profiling.

Feel free to contact us at any time at info@outbackin.com.au or 0438 191 618/ 0409 464 661
Should be Empty:

2024 Emerging Leaders Program Registration Form

PARTICIPANT DETAILS

INVOICING DETAILS