Northern Business Liaison Group Application Form

Required fields are marked with an asterisk (*).

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 would you 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 six weeks

Please provide two referees

Referee one full name *

Referee one phone *

Referee one email *

Referee one relationship to you *

Referee two full name *

Referee two phone *

Referee two email *

Referee two relationship to you *

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

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