Committee Nomination Form
  1. Name
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  2. Address
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  3. Email address(*)
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  4. Name of Committee(*)
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  5. Why you are nominating for this committee?
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  6. 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?
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  7. What experience have you had as a consumer representative?
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  8. Please provide any other information relevant to your nomination. Include professional qualifications, work history or other experiences related to the area or to health consumer issues more generally.
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