Consumer Representation: Expression of Interest Form

Cancer Voices has developed a database of trained informed consumers who are able to reflect the broad needs of Australians affected by cancer – to the best of their ability.

We are always keen to welcome new ‘voices’ who would like to be active in the areas around diagnosis, information, treatment, research, support, care, survivorship and policy. We do this by nominating suitable consumers to those decision-makers who have made a request for consumer input via our online Request for Consumer Representation Form. This way the consumer perspective is heard and headed…it’s an important and very worthwhile thing to do.

Please complete the field below which will tell us about your interests and experience. This information will help us match you with requests for consumers to join committees or research projects/funding panels working in the après mentioned above.

Name *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone *
Email *
Age *
M/F *
Have you personally experienced cancer? *
What kind (e.g. melanoma), what stage (early, advanced, if known) and when (year/s of diagnosis).
Are you/have you been a carer for a person with cancer? *
What kind (e.g. melanoma), what stage (early, advanced, if known) and when (year/s of diagnosis).
Have you done consumer advocacy training? *
If YES, where and when? If NOT, would you like to?
Have you done Consumer Research Training? *
If YES, where and when? If NOT, would you like to?
Please tell us of any particular interests or experience in cancer consumer advocacy, representation or consumer involvement in research *
Do you belong to an organisation or network of other cancer consumers? *
If YES, please provide name
Next steps
1. Receiving a Request for Consumer Rep Form with details of the committee or project, we will check our database to find suitable matches, using the information you have given us.
2. If there seems to be a good match, we will phone and send you the details supplied by the requester which provide what you need to know to decide if you will accept the position.
3. If you do, we then contact the requester with your email address, postal address and telephone number.
4. If you have any concerns, get in touch with us. We will not pass on any of this information in any other way, other than to add you to our email loop list for news updates.

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