Northern BLG application form

Important, please read before completing form.

Required fields are marked with an asterisk (*). Please ensure all required fields are completed before you click submit. After you click submit, please do not close the page until the confirmation message appears, otherwise your responses may be lost.

First name *

Last name *

Phone *

Email *

Name of business or organisation you represent *

What is your role or position in the business? *

Business or organisation address *

Business or organisation phone

Business or organisation website

What industry or sector do you represent?

Briefly describe why you would like to join the Northern Business Liaison Group *

What experience and knowledge can you bring to the Northern Business Liaison Group? *

Are you involved in any local community or business activities, initiatives, or associations? If so, please provide more details on these.

Confirm * Tick this box to confirm you are committed to attending meetings every 6 weeks

Please provide one referee

Referee full name *

Referee phone *

Referee email *

Referee relationship to you *

Before submitting your application you must advise the listed referee that the North East Link Program is collecting their information. View the MTIA Privacy Policy

Consent to collect information * Tick this box to confirm that you have advised the listed referee that the North East Link Program is collecting their information.