Please register your request below:
Email address *
Organisation name *
Your answer
Organisation type
Contact person *
Your answer
Contact person's position
Your answer
Phone number *
Your answer
Postal address *
Your answer
Closing date/deadline *
MM
/
DD
/
YYYY
How can Health Issues Centre support you?
Name of committee/project/event *
Your answer
Describe how the consumer/s will be involved (committee member, focus group participant, speaker, panel member etc) :
Your answer
For committees, what's the estimated time commitment for consumers?
Your answer
Date of event/first meeting
MM
/
DD
/
YYYY
Duration, day of week and time of event/meeting if known.
Your answer
Is this a new committee, or is it already meeting?
Meeting format
Meeting location
Your answer
For workshops, conference or other events, include the date, time and venue. If you are seeking a consumer to speak/be on a panel, remember to include details of when/what format presentations will be required.
Your answer
Tell us what skills, experience and interests you're looking for:
How will you appoint consumer(s) to the role? By interview process, meeting with committee Chair etc.
Your answer
Please respond to the following questions about support/remuneration/reimbursement. Health Issues Centre recommends that health services and health-related organisations inviting consumers to contribute to the planning of services and programs should offer them a sitting fee for their time.
Yes
No
Reimbursement of out-of-pocket expenses (parking, cab charge, other travel costs
Sitting fee
Administrative support (meeting documentation provided in hard copy, visitors passes coordinated etc)
Induction/orientation/training provided
That's it, unless there's anything else you'd like us to know...
Your answer
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