ENTRY FORMABOUT YOUR BUSINESSWhat is your registered business name? If not registered, please type N/A.Contact person:What is your position in the business / organisation?What is your ABN?If not registered, please type N/A.Business street address: Please include your suburb and post code.Postal address:

Business phone number:Email address:Business website:Website containing information about your innovation (if different to your business website)

How would you prefer us to contact you?☐ Email☐ Business phone☐ Mobile

In what local government area is your principal place of business?

☐ Aurukun Shire☐ Burke Shire☐ Cairns Regional Council☐ Carpentaria Shire☐ Cassowary Coast Regional Council☐ Cook Shire☐ Croydon Shire☐ Doomadgee Aboriginal Shire☐ Douglas Shire☐ Etheridge Shire☐ Hope Vale Aboriginal Shire☐ Kowanyama Aboriginal Shire☐ Lockhart River Aboriginal Shire☐ Mapoon Aboriginal Shire☐ Mareeba Shire☐ Mornington Shire☐ Napranum Aboriginal Shire☐ Northern Peninsula Area Regional Council☐ Pormpuraaw Aboriginal Shire☐ Tablelands Regional Council☐ Torres Shire☐ Torres Strait Island Regional Council☐ Weipa Town Authority☐ Wujal Wujal Aboriginal Shire☐ Yarrabah Aboriginal Shire

Which Major Award category are you entering? (Note: you may enter more than one category, but you must submit a separate form for each category.)

☐ Proven innovation = products, processes or services in the post-commercialisation stage.

☐ Pipeline innovation = innovation in development stage, not yet available on market

Did you previously win an award for this same innovation in the 2016 TNQIAs?

If you won the Best Proven Product, Best Proven Process, Best Pipeline Product, Best Pipeline Process, Eco Innovation, Indigenous Innovation, People's Choice or Mayor's Inspire Award, you are not eligible to enter the same innovation again in 2018. You can only submit an entry for a different innovative product, process or service.

☐ Yes☐ No

If you are named as a Finalist, do you consent to your entry being included in the People's Choice voting? The judges will choose a shortlist of entrants for public voting.

☐ Yes☐ No

ABOUT YOUR BUSINESS

Please provide a short background about you/your business/organisation (150 word limit)

Outline the core values of your business/organisation and how you demonstrate your commitment to social, community and/or environmental initiatives. (500 word limit)

ABOUT YOUR INVENTION / INNOVATION

What is the name of your invention/innovation? This is the name that Council will use in any promotion, publicity and the People's Choice awards (if applicable).

Provide a brief summary of your invention/innovation. (150 word limit)

Indicate the current stage of your innovation:

☐ Pipeline - prototype / proof of concept☐ Pipeline - development / scoping / testing☐ Proven - commercially launched / new to market within last 2 years☐ Proven - established in market / in growth stage

Provide any other comments about your project stage (optional): (500 word limit)

Why do you consider your product, process or service to be innovative? (500 word limit)

How did you go about developing your innovation/invention? (500 word limit)

Who was involved with the development of your innovation/invention? (500 word limit)

What problem or need does your invention / innovation solve and how? (500 word limit)

Has your invention/innovation delivered benefit to your business/operation? If so, how? (500 word limit)

Has your invention/innovation delivered benefit to others (e.g. customers, community). If so, how? (500 word limit)

MARKET & COMPETITOR ANALYSIS

Who are your competitors? What are they offering? (500 word limit)

How does your invention/innovation differ from your competitors? Does it provide better value for money than competing products or services? (500 word limit)

Describe your customers and current/potential market. How big is it? What growth opportunities care available (either domestic or export, or both)? (500 word limit)

How does your invention/innovation deliver economic benefits to the Tropical North Queensland region (eg, job creation, exports, industry diversification etc)? (500 word limit)

What type of non-financial assistance do you require to take your innovation to the next level?

☐ Business planning☐ Legal advice☐ Mentoring☐ Marketing plan☐ Attracting investment☐ Technical advice☐ Market research☐ Networking☐ Prototyping☐ Manufacturing

SPECIALITY AWARD QUESTIONS (OPTIONAL)

In addition to the Major Awards, there are also four Specialty Awards: Eco Innovation Award, Indigenous Innovation Award, Social Impact Award and the Young Entrepreneur’s Award (only for entrants aged under 25 years as at 15 August 2018).

If you choose to enter a Speciality Award, you will be required to answer additional questions to support your entry. If you don’t wish to enter a Specialty Award skip to the Intellectual

Property section.

ECO INNOVATION AWARDTell us about your invention/innovation's specific environmental and sustainability benefits. (500 word limit)

INDIGENOUS INNOVATION AWARDProvide details on the Indigenous links for your organisation/innovation/invention. (500 word limit)

Please provide evidence of your or your organisation's Aboriginality or Torres Strait Islander descent.

This can be in the form of a statutory declaration confirming Aboriginal or Torres Strait Islander descent or a document executed by an organisation of Aboriginal or Torres Strait Islander descent. Please refer to the Award Guidelines for more information.

SOCIAL INNOVATION AWARDDemonstrate how your organisation is providing new solutions to social issues to create or enhance social value. Identify community partnerships and support involved. (500 word limit)

YOUNG ENTREPRENEUR’S AWARD

Are you still at school?☐ Yes (if yes what grade are you in?)

☐ No (if no what year did you finish school?)

If you are under 18 years of age, please ensure your parent or guardian consents to you participating in these Awards and ensuring you comply with the TNQIA 2018 Terms and Conditions.

INTELLECTUAL PROPERTY

Have your registered any intellectual property for your invention/innovation? e.g., patent, trademark, registered design etc.

☐ Yes☐ No

If yes, what applications are relevant?☐ Patent

What stage is your patent application? Please include patent / application number:

☐ Trade Mark☐ Registered Design☐ Plant Breeders Rights☐ Other – Please specify

SUPPORTING INFORMATION

Please provide any supporting files to support your entry. This could be images, marketing material and supporting documentation. Format of documents can be .doc, .docx, .txt, .jpg; .tiff; .pdf; .eps or .png.

Logo: Please provide your company logo (JPG or PDF file format suitable for print and digital uses) this may be used by Council in the awards presentation multimedia and other promotions.

Hero Image: Please provide a high quality "hero" image that showcases your invention / innovation. This may be used by Council in the awards presentation multimedia and other promotions.

PLEASE NOTE: We do NOT accept or send files via WeTransfer

CONSENT AND ACCEPTANCE OF TERMS & CONDITIONS

It is a condition of entry that you agree to our Terms and Conditions. You will not be able to submit your entry without confirming your agreement. I agree to the terms and conditions of the TNQIA 2018 awards as stated on the TNQIA website at www.innovatetnq.com.au.

☐ Yes☐ No

Council would like to use elements of your application for media and marketing purposes. Please indicate your level of consent:

☐ My application is NOT commercial in confidence. I consent to Council using elements of my application for media and marketing purposes.

☐ This application is strictly COMMERCIAL IN CONFIDENCE. Please contact me prior to using any elements of my application for media and marketing purposes.

FEEDBACK

How did you hear about the 2018 Tropical North Queensland Innovation Awards?☐ Direct mail/email☐ Council enewsletter☐ Council Facebook☐ Council or TNQIA website☐ TV ad☐ Newspaper/magazine ad or article☐ Social media (other)☐ Word of mouth/networks

SUBMIT

Congratulations! You have completed your application for the 2018 Tropical North Queensland Innovation Awards. Please submit your application to economicdevelopment@cairns.qld.gov.au.