Please provide the following contact information

Name
Organisation
Address
State	Please choose QLD NSW ACT VIC TAS SA WA NT N/A
Phone
Email

  I am a: 

           please choose Consumer Family / carer Support worker Health practitioner Health services manager Health researcher Community organisation representative Government officer

  My Medicare Local is: 

           please choose ACT ACT Medicare Local NT NT Medicare Local NSW Eastern Sydney Medicare Local Far West Medicare Local Hunter Rural Medicare Local Hunter Urban Medicare Local Illawarra-Shoalhaven Medicare Local Inner West Medicare Local Murrumbidgee Medicare Local Nepean-Blue Mountains Medicare Local New England Medicare Local North Coast Medicare Local North Eastern Sydney Medicare Local Northern Sydney Medicare Local South Eastern Sydney Medicare Local South Western Sydney Medicare Local Southern Highlands Medicare Local Southern NSW Medicare Local Western Sydney Medicare Local Western NSW Medicare Local QLD Central and North West Medicare Local Central Queensland Medicare Local Darling Downs-South West Medicare Local Far North Medicare Local Gold Coast Medicare Local Greater Metro South Brisbane Medicare Local Metro North Brisbane Medicare Local Moreton Bay Medicare Local Sunshine Coast Medicare Local Townsville-Mackay Medicare Local West Moreton-Oxley Medicare Local Wide Bay Medicare Local SA Central Adelaide and Hills Medicare Local Country North SA Medicare Local Country South SA Medicare Local Northern Adelaide Medicare Local Southern Adelaide-Fleurieu Medicare Local TAS Tasmania Medicare Local VIC Barwon Medicare Local Bayside Medicare Local Frankston Mornington-Peninsula Medicare Local Gippsland Medicare Local Goulburn Valley Medicare Local Grampians Medicare Local Great South Coast Medicare Local Hume Medicare Local Inner East Melbourne Medicare Local Inner North West Melbourne Medicare Local Lodden Mallee Medicare Local Lower Mallee Murray Medicare Local Macedon Ranges and North Western Melbourne Medicare Local Northern Melbourne Medicare Local South East Melbourne Medicare Local South Western Melbourne Medicare Local WA Bentley-Armadale Medicare Local East Metro Medicare Local Fremantle Medicare Local Goldfields Midwest Medicare Local Kimberley Pilbara Medicare Local Perth North Metro Medicare Local Rockingham-Kwinana-Peel Medicare Local South West WA Medicare Local


I would like to act as a Convenor in my Medicare Local.

I would like to participate in developing consumer-centred innovations in my Medicare Local.

I am interested in the following areas:

         Mental health
         Chronic illness
         Ageing
         Self-managed packages of care
         Home-based management of complex care
         Health management tools
         e-Health

I would like to act as a Team Leader for the Campaign in the following area:

         Mental health
         Chronic illness
         Ageing
         Self-managed packages of care
         Home-based management of complex care
         Health management tools
         e-Health
      
  I have skills in social media management and would like to offer these.

  I would like a speaker to visit our group or organisation to talk about the Campaign for Consumer-Centred Health Care.

Tell us about your interest in consumer-centred health care: