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 representatives in NSW, ACT and SA. Fill in the form below by 5pm (AEDT) Friday 18 December 2020 to confirm your expression of interest. 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!