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Nomination Form

Your Details
*Name
*Postal Address
*State
*Postcode
*Email
Nomination
*Name of committee you are nominating for
Why are you nominating for this Committee / Working Party? Why does it interest you?
What consumer experience and knowledge do you have in the area? For example, are you a consumer in this area or do you have strong links to those who are?Note: formal qualifications or training are not expected for consumer representation.
What experience have you had as a consumer representative? Include any existing/previous committee experience.
Please provide any other information relevant to your nomination, for example professional qualifications, work history or other experience related to the area or to health consumer issues more generally.
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