Consumer Representative Request Form

  • As our Consumer Representatives Program is currently running close to capacity, HCCA has identified the following priority areas. Please select which of these areas are relevant to your committee. Please note: if your committee falls outside of these areas, HCCA will still process your request.
  • Max. file size: 2 MB.
  • Please ensure all fields are completed before submitting your request. We cannot begin our processes to endorse an appropriate consumer representative without all of this information.

Last updated: 5/10/2018