Nomination Form - Road to Success

* Required Field

I am nominating myself

I am nominating someone else. I have notified them of their nomination and received their approval

Nominee

First Name *Required

Last Name *Required

Position *Required

Organisation *Required

Address *Required

City *Required

State

Postcode *Required

Phone (mobile preferred) *Required

Email *Required

Nominator Details

First Name *Required

Last Name *Required

Position *Required

Organisation *Required

Address *Required

City *Required

State

Postcode *Required

Phone (mobile preferred) *Required

Email *Required

Nominee Deatils

Which diversity type best represents the nominee? (You may select more than one option) *Required

Please specify your diversity *Required

Describe the nominee’s character, personality and what makes them diverse. *Required

What does diversity mean to the nominee? *Required

What is the nominee’s vision for diversity in the trucking industry? What would they like to see in the future? *Required

What outcomes would the nominee like to receive as a programme participant? *Required

The nominee is a member of

Transporting New Zealand

National Road Carriers (NRC)

NZ Trucking

Other

Please specify who you are a member of *Required

As part of your application for the Driving Change Diversity Programme please confirm the below *Required

The nominee confirms they are available to travel to the Ia Ara Aotearoa Transporting New Zealand Conference to participate in the workshop programme and ATA conference. The nominee consents to participating in video filming in my workplace, and the use of any photography or video captured during the programme for programme promotional activities.

We take your privacy seriously and understand the need to keep your information confidential and secure. You can access or correct information we have about you by emailing [email protected]
For more information on how we collect, use and disclose information about you from this form, or to view the Ia Ara Aotearoa Transporting New Zealand’s privacy policy, please contact [email protected]

Road to success Driving Change Diversity Programme nomination form

Become a driver

Course info:

Host a trainee

Road Transport Forum