Executive Mastermind EOI

To express interest in the Executive Mastermind please fill in the form below:

Executive Mastermind EOI

Enrolment form for participation in Future Shapers Program 2026

Your name * Required
Your email address * Required
Repeat your email address * Required
Today's date - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY
Your phone number * Required
We mainly use email or zoom, but need a phone number in case you are unable to be contacted. Don't forget country & area code.
7 + 6 = * Required
So we know you aren't a robot
I am a disabled person / person with disability * Required
- No
- Yes
What is your current role? * Required
The Executive Mastermind is designed for executive management level disability leaders. Please name your position and give a brief description of how it aligns with executive leadership.
What will you bring to the Mastermind? (A Mastermind is a peer led cohort of equals.) * Required
What are your leadership goals or outcomes? * Required
What would you like to achieve through participating in the Mastermind, and over the next 3 years?
Your commitment * Required
Please agree to the following:
- I understand that this is an active participatory community of practice which includes 3 in person workshops and ongoing discussion with my colleagues. I commit to actively participating and bringing my expertise to the group.
First workshop dates: * Required
Please select one or both of the below dates that you are able to attend the first full day workshop to be held in Canberra. Note: you are responsible for all travel and accommodation costs.
- Friday 27 March 2026
- Friday 17 April 2026
Program Fee: * Required
The Executive Mastermind fee is $3000 +GST per participant. Please provide details for invoicing below including: Name of organisation being invoiced; Attention to; any purchase order number if used. Please indicate if you would like to add the Global Leadership Profile to your invoice ($1200 +GST).
*Accessibility requirements
Please note: your disability access requirements should not prevent you from participating. We ask this question to assist us with any adjustments you may require. Please contact us if you have any questions.