Expression of Interest

You should understand your goals and be clear about what successful participation looks like.

Last Name

First Name

Phone Number

Job Title

Are you a current member of the Geelong Chamber of Commerce?*

Organisation Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Employees

Website

What areas within the business would you like to improve on or have support in?

Tell us why you would like to join the program?

What areas of personal development would you like to work on?

What is it about your current situation that you may want to change?

WWhat else would you like to get out of the program? *

What else would you like to get out of the program? *

I understand I am required to attend a minimum of 8 sessions of the program. *

I would prefer to pay the annual cost of the program.

Please select one of the below payment methods. *

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