Online Application Form

Applications may be submitted to join the waiting list.

Personal Details
Full Name*
Required - first and last name
Gender*
Required
Organisation/Group/Community*
Required - Please list all organisations, groups and communities you will be representing at the Summit, separated by commas
Do you identify as an Aboriginal/Torres Strait Islander?*
Required
Business Hours Telephone*
Required
Email*
Re-Enter Your Email*
For verification
Postal Address*
Required
Suburb*
Required
State*
Required
Postcode*
Required
Personal Introduction
In 100 words or less, please tell us about yourself (for inclusion in the Summit publication)*
Required
Summit Statement
In 100 words or less please tell us your reason/s for applying to join the Summit (for inclusion in the Summit publication)*
Required
Transport Options
Monday 26 July 2011
(departures scheduled from Broome at regular intervals from 6.00am)
Preferred mode of transport to Billard Aboriginal Community from Broome*
Required
Friday 29 July 2011
(departures scheduled from Billard at regular intervals from 8.30am)
[book transport to depart Broome anytime from 12.00pm]
Preferred mode of transport to Broome from Billard Aboriginal Community*
Required
Other Required Information
Dietary Requirements*
Required
Please specify other dietary requirements*
Required
Medical Conditions*
Required
Please specify notifiable condition*
Required
Body Weight (kg)*
Required - For meeting payload requirements on air charter/s (please complete even if air charter is not your preferred mode of travel, in case of evacuation)
T-shirt Size*
Required
Payment Arrangements
Please select method of payment for registration fee of $2,690 inc GST*
Required
Please provide details for Tax Invoice as follows:
Invoice Name
The name of the agency/organisation on the Tax Invoice
Invoice Address
Please note that the Tax Invoice will be forwarded to you for processing in your organisation.
Sponsorship Information
In 100 words or less please tell us your reason/s for applying for SPONSORSHIP to join the summit as a key contributor*
Required
Referee Name*
Required
Referee Business Hours Telephone*
Required
Why have you suggested this person as a supporting referee?*
Required
Please provide details of best travel options to Broome from your home community*
Required
Summit Commitment
In applying to join the Blank Page Summit Hard Yarn 2011, you are advised that the following procedures apply to all participants - please avoid embarassment by carefully reading and assessing if it is appropriate for you to join the Summit prior to making your application:

All transport movements from Broome will commence from 6.00am on Monday 25 July 2011, therefore it is necessary to arrive in Broome no later than the evening of Sunday 24 July 2011.

Vehicles belonging to Summit participants are not permitted at Billard Aboriginal Community during the Summit.

The Blank Page Summit runs from Monday 25 July 2011 to Friday 29 July 2011 and there is no provision for part-attendance by coming and going during the event.

Billard Aboriginal Community is an alcohol and drug-free community.

Billard Aboriginal Community is a 'no humbug' community which means that visitors are expected to co-operate with each other and the Summit organisers to ensure smooth running of the event and to act in good faith in relation to the purpose and principles of the Summit.

If I join the Blank Page Summit Hard Yarn 2011, I agree to:

arrive in Broome no later than the evening of Sunday 24 July 2011;

travel to Billard Aboriginal Community by transport arranged by Summit organisers;

participate in the Summit for its entire duration from Monday to Friday;

observe the alcohol and drug-free policies of Billard Aboriginal Community; and

act in good faith with the Summit organisers and participants in relation to the purpose and principles of the Blank Page Summit.

*
I agree to the Summit Commitment
Required

Personal Details

Personal Introduction

Summit Statement

Transport Options

Other Required Information

Payment Arrangements

Please provide details for Tax Invoice as follows:

Sponsorship Information

Summit Commitment

Apply

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