Community Liaison Group Expression of Interest - Muscular Dystrophy Queensland

Community Liaison Group Expression of Interest Form

* Mandatory fields

Thanks for your interest in joining the Community Liaison Group. We are interested to know about you, your background and your circumstances. This information will assist us to select a diverse range of people to represent the interests and experiences of the neuromuscular community in Queensland. Not all of the questions are compulsory. Please only provide the information you are comfortable sharing with us.

Applicant details

About you

Your relationship with Muscular Dystrophy Queensland. Please select the most relevant to you:*
I am able to use digital conferencing (eg. Microsoft Teams is our preferred software).*
For Example: parent of a child with a neuromuscular condition, young adult, working person, retired person.
Example: Available days of the week and times. e.g. during work hours/outside working hours/anytime.
Example: you might have an interest in organising social gatherings/engagement for the community, providing fundraising leadership or leadership in another common area of interest
Are you happy to have your name published if your application is successful?*
Being open to having your name published is not a requirement as a member of the CLG. Your answer will help us manage the information we publish about your involvement. We are committed to protecting your privacy and will only share information about your with your consent.
Do you (or your family member) have funding for your disability related needs?*

Your diversity information

Location
Age Range
If yes, please describe your cultural, ethnic or ethno-religious background.
If yes, are you of Indigenous Australian decent or Torres Strait Islander decent?
For example, you may wish to share that you identify as gender non-conforming, your LGBTIQA+ orientation, or your preferred pronouns.