Complete this form to publicly support our campaign calling on the NT Government to recognize and support a NT wide lived experience representative body.  

You are only required to answer Questions 1 to 3 to submit your support. 

You can choose to answer Questions 4 to 8 if you want to:
4) Publicly identify yourself as a person with lived experience (individual, family member/kin or unspecified).  
5) Publicly identify your professional role and/or place of employment. 
6) Provide your email address to the NT Lived Experience Network so that we can stay in touch about our work.
7) Lend your additional support to the NT Lived Experience Network to be recognized and supported by the NT Government as a NT-wide representative body.
8) Share your additional thoughts or comments.

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* 1. What state or territory are you from?

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* 2. What is your postcode?

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* 3. What name would you like to be identified by?

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* 4. Optional: Do you have lived experience? (tick all that apply)

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* 5. Optional: What is your professional role and/or place of employment?

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* 6. Optional: Provide your email address if you would like us to stay in touch.

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* 7. Optional: Check this box if you support the NT Lived Experience Network to be recognized and supported by the NT Government as a NT-wide representative body. 

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* 8. Optional: Additional thoughts or comments

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