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BCNA DEI Consultation Registration Form

Your details
Name(Required.)
Email address(Required.)
Pronouns (optional)
About you
Which of the following best describes your experience with breast cancer? (Select one)(Required.)
Are you a carer, family member or support person of someone affected by breast cancer?(Required.)
Please describe any accessibility, communication or support requirements you have that we should be aware of.
Consultation sessions
Please indicate the consultation sessions that reflect your lived experience and that you are available to attend. You are welcome to express your interest in participating in more than one consultation group when registering, however you will only be selected for one session.
Additional consultation option
These consultation groups are intended to bring together people with shared lived experiences. We recognise that many people identify with more than one group.

If none of the groups listed above reflect your experience, or if you would like to contribute in another way, please tell us about your perspective and availability below and our team will be in touch regarding additional consultation opportunities.
Please tell us about your lived experience or perspective.
Please let us know your availability.
Privacy and consent
By submitting this form, I agree to Breast Cancer Network Australia collecting and holding the personal, sensitive and health information I have provided in accordance with its Privacy Policy, and using such information to facilitate this program.(Required.)