Registration of InterestTo register your interest in the Transform Initiative simply fill in this form and return it either by email, fax, or post to the following address by the 15th January 2007.

Transform Initiativec/o Locus Research LtdP.O. Box 4141 Mt MaunganuiEmail: info@transform.org.nzFax: 07 927 3133Phone: 07 571 5007

1. Please fill in your contact details below:

Business Name: Contact Name:

Address: Phone Number:

Email Address:

2. What industry sector does your business operates in? (Please circle)

Textiles Carpet Footwear Apparel

3. What statement best describes the core business of your company/organisation? (Please tick box)

Material processing/manufactureProduct developmentProduct manufacturingTechnology developmentOther (please specify)

4. What statement best describes your company? (Please tick box)

Don’t generally undertake new product development and have no research and development capacity.Undertake some product development and have a small capacity for research and development.Regularly undertake new product development and have a medium capacity for research and development.Have an extensive range of projects underway at any one time and have a large capacity for research and development.

5. I would like to be involved in the Transform initiative and would like: (Please tick box)

Someone to contact me about the initiative To put forward a proposal outline (proceed to question 6)

6. Please broadly describe your proposed development project? Please attach another page if required (maximum 500 words)

Project Title:

Project Description:

All information provided will remain confidential and will only be used by the Transform project team for the purposes of developing the Transform Initiative. Copyright ©Textiles NZ 2006

Administration Use Only

Project ID #:

Reviewed By:

Contacted By:

Date Logged:

Proposal Structure

Textiles New Zealand is not looking for complete proposals at this time. The aim is to quickly identify what companies would like to be involved, and what new or existing ideas or projects could be included and funded by this programme.

To register your interest and put forward a proposal outline, please fill in the Transform Application Form in the centre of this document.

All information provided will held in the strictest confidence and will used only in the context of this project and would be securely disposed once the identification and selection process has been completed.

The closing date for initial proposal outlines and registrations of interest close on the 15thth January 2006.

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