Marcus Oldham Rural Leadership Program Application

Marcus Oldham Rural Leadership Program

Sunday 28th August to Friday 2nd September 2022

Early bird applications must be submitted by COB on the 30th June 2022
This is a:*
- Early Bird Application $2800
- Full Fee Application $3300
Early Bird Applications are only accepted up until the 30th June 2022. Full fee applications are accepted after the early bird closing date until the 29th July 2022.
Personal Details
Name*
First Name Surname Preferred Name (for name tag)
Address*
Street Address Address Line 2 or Property Name Suburb State / Territory Post Code
Email*
Mobile*
Work Phone
Current Age*
Gender*
- Male
- Female
- Other

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Formal Education History
Please list your formal education to date.*
Please list here any current leadership roles you fulfill within your community, business or industry. Also, list any other leadership roles you may like to fulfill in the future.

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Two Personal Referees
Name*
First Last
Relationship*
Phone Number (Business Hours)
Mobile Number
Name*
First Last
Relationship*
Phone Number (Business Hours)
Mobile Number
Agriculture - Which way next?
Please set out what you would like to achieve as a leader in agriculture (250 words or less).*

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Individual Requirements

If you have any dietary, learning, physical mobility or other individual requirements that we may be able to assist you with, please let us know.
Dietary Requirements
- None
- Gluten Free
- Nut Free
- Dairy Free
- Egg Free
- Vegetarian
- Vegan
- FODMAP
- Other
Other Dietary Requirements
Please list any other dietary requirements.
Other Requirements
If you have any learning, visual, physical mobility or other individual requirements we should be aware of, please list them here.

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If you are unsuccessful in your application, you will receive a full refund
Please nominate your payment method*
- Credit Card
- Direct Deposit/Invoice
- Cheque
Please send a cheque made out to Marcus Oldham College to:

Private Bag 116, Geelong Mail Centre, Victoria, 3211, Australia

Early Bird (by 30th June 2022) - $2800

Full Fee (after 30th June 2022) - $3300
Please make a payment to the following account and include your surname and MORLP September 2022 as the payment description.

BSB 013-523

Account: 2538 603 16

Account Name: Marcus Oldham College
Who would you like the invoice made out to?*
- Myself
- My sponsor
Marcus Oldham Rural Leadership Program September 2022 - Early Bird Fee
Price:
Marcus Oldham Rural Leadership Program September 2022 - Full Fee
Price:
Total
$ 0.00
Credit Card

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

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Marcus Oldham Rural Leadership Program