HCRA acknowledges the importance of actively involving consumers in cancer research, and is seeking to establish a panel of local consumer advocates in 2016 and beyond. Members of the HCRA Consumer Advisory Panel will provide advice, guidance and recommendations to HCRA and its members from a consumer perspective.

To register your interest in joining the HCRA Consumer Advisory Panel please take a couple of minutes to complete this expression of interest form.

If you have any questions along the way please don't hesitate to call us on 02 4042 0862 or email HCRA@newcastle.edu.au

Your contact details

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* 1. Your contact details

Date of birth

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* 2. Date of birth

Your birthday
Do you identify as being of Aboriginal or Torres Strait Islander descent?

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* 3. Do you identify as being of Aboriginal or Torres Strait Islander descent?

What has been your experience with cancer?

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* 4. What has been your experience with cancer?

How would you prefer for HCRA to contact you?

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* 5. How would you prefer for HCRA to contact you?

How often would you like to be contacted regarding HCRA Consumer Advisory Panel activities?

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* 6. How often would you like to be contacted regarding HCRA Consumer Advisory Panel activities?

Please comment briefly on why you would like to become involved with the HCRA Consumer Advisory Panel

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* 7. Please comment briefly on why you would like to become involved with the HCRA Consumer Advisory Panel

Are there any areas of cancer/research that you have experience and/or an interest in?

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* 8. Are there any areas of cancer/research that you have experience and/or an interest in?

Thank you for expressing an interest in partnering with HCRA as a consumer advocate. All information that we have requested in this form is voluntary; we have asked these questions so that we can ensure that all voices in the community well represented in HCRA CAP activities and so that we can effectively engage and communicate with you. Information provided will be kept confidential within the HCRA Management Team and will only be used to support the activities of the HCRA.

Should you have any questions or concerns regarding this nomination form please contact us on phone: 02 4042 0862 or email: HCRA@newcastle.edu.au

Once you submit this form you can expect that a member of the HCRA Operations team will make contact with you within one month. Thank you again!

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