Conference/Workshop Attendance Expression of Interest
  1. Conference/Event(*)
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  2. Name(*)
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  3. Address(*)
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  4. Phone(*)
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  5. Email
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  6. Do you live on a government pension?(*)


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  7. Are you a low income earner?(*)


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  8. Please give a brief outline of your consumer representative experience in relation to health service planning or policy development.
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    Up to 200 words.
  9. Please give examples of any relevant consumer representation (*)
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    Up to 200 words.
  10. If selected to participate in this conference/workshop, how will you share your conference experiences with HCCA and other relevant organisations/people?
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    Up to 200 words.