VMIAC Consumer Register Expression of Interest

  • Expression of Interest

    VMIAC Consumer Register

  • A PDF preview of this form can be downloaded here.

     

    Purpose Statement

    This web form is intended to collect information related to your expression of interest in joining the VMIAC Consumer Register. More information about the VMIAC Consumer Register is available on our website at vmiac.org.au/get-involved/register.

    Privacy

    This web form requests personal health information. All information you provide to VMIAC will be kept securely in accordance with the VMIAC Privacy Policy, the Privacy Act 1988 and the Health Records Act 2001. The information you provide to us will be used only for purposes related to VMIAC Register opportunities.

    You own all data you provide to us. You are free to request or make changes to your data at any time. It is also your right to ask us to destroy all data you provide to us. You can make these changes to your data by contacting VMIAC at consumerregister@vmiac.org.au.

    How to complete this form

    This form begins with a Prerequisites Section. It takes about 5 minutes to complete this section.

    After successful completion of the Prerequisites Section, there are an additional 5 sections to complete. These 5 sections require around 15 minutes to complete.

    If you are unable to complete the Prerequisites Section, or require assistance to complete this form, please contact consumerregister@vmiac.org.au or (03) 9380 3900.

    Please click on the button below to proceed.

  • Pre-requisites Section

    Your safety and wellbeing are important to us. To participate in the VMIAC Consumer Register safely, we require that you meet the criteria listed on the VMIAC website.
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  • Guidance: Date of Birth
    VMIAC requires your date of birth for child safety reasons. If you do not wish to provide your full date of birth, you may enter "1 January" and your birth year.

  • Your Contact Information


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  • About You

  • The information that you provide below will be de-identified and aggregated, so that we can count how many diverse perspectives and identities are represented in the Consumer Register.

    This information will help us work with the Department of Health and other service providers in developing engagement opportunities.

    We may also use this information to fulfill funding or regulatory obligations.

  • Section 2: Lived Experience

  • We request this information as some opportunities are related to specific lived experiences. By providing this information, we will be better able to match your lived experience to available opportunities.

    You can make changes to your lived experience details at any time after you submit this survey.

  • Tell us about your skills

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  • The following skills are essential for participation in the Consumer Register. Please let us know how you feel about your skills in:

    (you may select either or both options if you prefer.)

  • The following skills are desirable for participation in the Consumer Register. Please let us know how you feel about your skills in:

    (you may select either or both options if you prefer.)

  • Section 4: Opportunities and Training

  • Sorry :(

  • Unfortunately, we are unable to proceed with your expression of interest to join the VMIAC Consumer Register via this webform. 

    We encourage you to contact consumerregister@vmiac.org.au or (03) 9380 3900 to discuss your interest. 

    We would like to take this opportunity to invite you to join VMIAC as a member to take advantage of our member opportunities and events.

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