Join the ANZ-LCNF Steering Committee! Submit your Expression of Interest Are you passionate about patient care in lung cancer and want to bring your experience to a national level? Do you want to support and develop the lung cancer nursing profession? We currently have vacancies on the ANZ-LCNF Steering Committee for QLD and VIC state representatives and nurse practitioner and nurse researcher representatives. To submit your interest, please complete the form below. OK Question Title * 1. What is your full name? OK Question Title * 2. What is your current position/s within thoracic oncology nursing? Job title 1: Employer 1: Job title 2: Employer 2: OK Question Title * 3. Please provide your best contact details Name Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number OK Question Title * 4. Please select your areas of experience and expertise Registered Nurse Enrolled Nurse Lung Cancer Nurse Coordinator Lung Cancer Nurse Specialist Cancer Care Coordinator / Nurse Chemo / Oncology (Competent) Nurse Radiation Nurse Support Group Facilitator / Peer Support Survivorship Care Nurse Practitioner Nurse Researcher Other (please specify) OK Question Title * 5. Please provide detail on your formal qualifications (complete additional rows as required) Title: Year of Completion: Institution: Title: Year of Completion: Institution: Title: Year of Completion: Institution: Title: Year of Completion: Institution: OK Question Title * 6. Do you have any training in progress? Yes No if Yes, please provide details and expected completion date OK Question Title * 7. Please provide a recent work history (up to 5 years) relevant to thoracic oncology nursing Job title 1: Employer 1: Job title 2: Employer 2: Job title 3: Employer 3: Job title 4: Employer 4: Job title 5: Employer 5: OK Question Title * 8. Please provide your professional endorsements on employer / institution letterhead Examples of professional endorsements include; Nurse Director, a Lead MDT Clinician at your hospital, Research Supervisor PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File Examples of professional endorsements include; Nurse Director, a Lead MDT Clinician at your hospital, Research Supervisor OK Question Title * 9. Written response:What motivates you to join the ANZ-LCNF Steering Committee? What difference do you hope to make to thoracic oncology nursing? 1 page max, 10 point Century Gothic font PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File 1 page max, 10 point Century Gothic font OK Question Title * 10. Is there anything else you would like us to know? OK THANK YOU!