Peer Register - Registration Form

Use this form to join the Register of Peers and register your interest in becoming a PATA Council member and/or taking
part in Council’s research activities.

Please complete this form as accurately as possible or you can down load the interactive Peer Registration form PDF fill it out
and Email to Info@pata.com.au or print and mail to:

PATA - Peer Register
PO Box 558
Yarraville Vic 3013

Contact the PATA Executive Officer on info@pata.com.au if you require any assistance or advice.

You should also read the accompanying Information Sheet and review the PATA website PATA News page for any updates.

 

1. Your Name & Contact Details

Title:






  Is Post Address is same as above
:
:

 

I confirm that I wish to be considered for appointment to the Performing Arts Touring Alliance Council.

I do not wish to be considered for appointment to the PATA Council but would like to receive
information from PATA about its activities and would be prepared to participate in PATA research projects.

* If you selected No, you are not required to fill out the rest of this form. You can simply click on the submit button at the bottom of this page. Please Complete if you wish to be considered for PATA Council.

 

2. My Interests

This section requires a brief outline of your interests, knowledge and experience. Further information may be requested if required
so summary level information only is needed at this point.

Experience & Expertise

Please provide a brief outline of your knowledge and experience - this should be as relevant as possible to the national
performing arts touring sector and your possible appointment (if applicable) as a Council Member:

Max 200 words.

Primary Interest

I would like join the PATA Council and/or participate in research activities as a representative of:
(tick one only and refer to the accompanying Information Sheet if required)




Other Expertise

If you have a broader range of knowledge and experience in national performing arts touring please provide a brief outline:

150 words max.

3. Referees - Optional at this stage

You are invited to provide the details of any referees who would support your application to become a PATA Councilor.
This is not a requirement at this point in the process.

 
Title:






:
:

 

4. My Ability To Participate as a Council Member

My employer supports my interest in becoming a PATA Councilor and would be prepared to sign the PATA MOU.


My employer would be prepared to financially support my participation in PATA Council activities.

5. Statistical Information

The following information is used to help us select Councilors. Your personal details will be treated in the strictest privacy
and in accordance with the Privacy Act 1988.






If so, what language do you use?:

What country were you born?:

If born overseas, what is your first language if not English?:

If born in Australia, What is the first language (if not English)
of one or both of your parents, or the person(s) who raised you?:

Identify your ancestry/ies:
(eg. English, Irish, Hmong, Kurdish, Vietnamese. Your ancestry describes
the ethnic or cultural group to which your forebears belonged and identified with
)

Do you have a disability?

 

6. Certification

I, the undersigned, certify that:

I agree to the personal details on this form and any attachments being recorded and used by PATA:

• for nomination to the Council of the Performing Arts Touring Alliance
• to participate in research and related policy development activities that may be undertaken by PATA.

I confirm that the details provided are correct to the best of my knowledge.

I have the approval of my nominated referees to offer their names and I have no objection to them being contacted without my further consent.

I have read and agree to the above conditions: