Queensland Leaders

Developing the next generation of international corporations headquartered in Queensland

Member Nomination Form

Queensland Leaders is focused on developing the next generation of international corporations headquartered in Queensland.

Each year Queensland Leaders selects up to 20 leading private sector companies from all the nominations received to become Queensland Leaders Members for 12 months.

Queensland Leaders will provide selected Members with access to the Knowledge, Networks and Capital to take their business to the next stage of growth and investment attraction. Members will receive ongoing education and mentoring from Queensland’s business and industry leaders.

Is your company the next Queensland Leader?

Benefits of being selected as a Queensland Leaders Member:

A structured, ongoing strategic mentoring and networking program with industry, government, and peers;
A trusted and exclusive network in which to promote services and opportunities;
Thirty (30) Knowledge Workshops in professional development and life skills;
Twenty (20) personal Mentoring Sessions with industry professionals, in an “Ask the Experts” format;
Exclusive attendance at ten (10) Networking Receptions with key government and industry leaders;
Invitations to private social networking occasions as organised on a regular basis;
Opportunity to present your company as the market leader in your industry.

Please complete the following details

The fields marked with an asterisk (*) are mandatory.

Part B: Company Details

Does the company have audited accounts?: *

Yes

Name of Account:

Is the company looking to raise equity/debt capital in the next 12 months?: *

Yes

What protected intellectual property does the company own? Please describe:

Locations of other company offices:

Number of Current Employees

Full Time: *

Part Time: *

Corporate Structure of Company: *

Is the company a subsidiary or affiliate of another company? If yes, Please describe the relationship that the companies share:

In less than 50 words please describe the business:

In less than 50 words please explain the attributes of the company that form a sustainable competitive advantage:

In less than 50 words please explain the strength of the management team:

Part C: Financial Details

(Please provide amounts in $A)

EBITDA

2005 - 2006: *

2006 - 2007: *

2007 - 2008: *

2008 - 2009: *

Net Tangible Assets

2005 - 2006: *

2006 - 2007: *

2007 - 2008: *

2008 - 2009: *

Yearly Revenue - Last 4 years

2005 - 2006: *

2006 - 2007: *

2007 - 2008: *

2008 - 2009: *

Please Note:

Applications not containing the minimum level of requested information will not be accepted;
Applications may be subject to ASIC and police background checks;
Further information may be requested by Queensland Leaders to assist the judging process. Failure to provide this information may result in your company’s disqualification;
The judge’s decisions are final. No discussion or correspondence will be entered in to.

Eligibility

Queensland Leaders welcomes all Queensland-based private and unlisted public companies to nominate, in keeping with the following key eligibility points:

The company has, or is building, a market leading brand, technology or skills base;
Business is a market leader or has the potential to be a market leader within its industry sector;
The company is in wealth creation mode and is seeking growth opportunities within the next 12 months;
The key executive/s are seeking the knowledge and networks to evolve their business to the next stage;
Executives are open to new ideas and thinking.

Member Contribution:

Queensland Leaders Members contribute $12,500 (+GST), which includes all events, workshops, catering, social events,
etc.

Judging Criteria

The judging panel consists of a broad range of individuals who each have extensive skills and experience in the funding and growing of international corporations. In addition to those items already mentioned, key judging criteria in the selection process include:

Personal and management skills, abilities and ethics of the Principal;
Strategic direction and vision for the company;
Previous 3 year’s financial performance;
Market insight, innovation and strategy;
Future national and international opportunities;
Potential to become a significant international listed public company.

The judges are looking for a handful of talented entrepreneurs that have the innovation and drive to become the next
Queensland Leaders.

Confidentiality

Any information about a company’s financial position, history and growth strategies will only be used by Queensland Leaders and the judging panel for the purposes of selecting the Queensland Leaders Members, and will be stringently treated as commercial-in-confidence. Any contact details may be provided to Sponsors, Partners and Alumni of Queensland Leaders.

Privacy

The Queensland Leaders Privacy Policy can be viewed here. Further information or clarification can be provided by
contacting Queensland Leaders by email (info@queenslandleaders.com.au) or phone (07 3230 8087).

Declaration

By submitting this nomination, the applicant declares that:

All information provided is true and correct;
You agree to abide by the terms and conditions of nomination noted on this page;
The company is free from legal investigation and is compliant with all Acts, Ordinances, Regulations and By-Laws, Orders, Awards, Licenses, Permits, Approvals and Requirements in respect to the operation of the
company.