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New Network Partner Application
Step
1
of
5
– Company Details
20%
Company Name
(Required)
Company ABN
(Required)
Company Registered Address
(Required)
Street Address
Address Line 2
Suburb
State
Postcode
Main Contact Person
This person will be the primary contact liaising with WiTWA representatives with regards to the implementation of DEI initiatives within your organisation.
Contact Name
(Required)
First
Last
Contact Email
(Required)
Contact Phone Number
(Required)
Authorised Signatory
This can be one of the contacts listed above OR a different contact but should be a person within your organisation with the authority to enter into a contract with WiTWA.
Is the primary contact also the authorised signatory?
Yes, this is the same person as the primary contact listed above
No, this is a different person from the primary contact listed above
Authorising Signatory Name
(Required)
First
Last
Authorising Signatory Email
(Required)
Authorising Signatory Phone Number
(Required)
Overview of experience and qualifications in the diversity, inclusion, equity and belonging space
(Required)
I give permission for WiTWA to contact the below references to discuss my work in this space
(Required)
Yes, I agree.
Reference One
Name
(Required)
Company
(Required)
Position
(Required)
Contact Phone Number
(Required)
Contact Email
(Required)
Reference Two
Name
(Required)
Company
(Required)
Position
(Required)
Contact Phone Number
(Required)
Contact Email
(Required)
Company Bio (up to 200 words) – What is your why/what/how?
(Required)
What is the service/product you offer within the DEI Space?
(Required)
What are you hoping our Corporate Members achieve, if they choose to work with you?
(Required)
What data/stats/testimonials do you have to demonstrate your service/product success?
(Required)
Team Photo or Headshot
(Required)
Drop files here or
Select files
Accepted file types: svg, ai, eps, pdf, png, jpg, Max. file size: 256 MB.
Logo File Upload
(Required)
Drop files here or
Select files
Accepted file types: svg, ai, eps, pdf, png, jpg, Max. file size: 256 MB.
Social Media Channels
We’d love to share information about our Network Partners with the greater WiTWA community. Let us know the best way to tag you!
LinkedIn
Facebook
Instagram
Twitter
LinkedIn Handle
(Required)
Facebook Handle
(Required)
Instagram Handle
(Required)
Twitter Handle
(Required)
Your Company’s commonly used social media hashtags
Any other information
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