Expression of interest in appointment to a Local Advisory Committee Are you expressing interest yourself or suggesting someone else for a Local Advisory Committee? (required) For myself - Please complete Section 1. For someone else - Please complete Sections 1 and 2. If you are suggesting someone else, please include your details in this section. We will then contact the nominee using the details provided in Section 1. We may share your details with the person you are suggesting. SECTION 1 - Your personal details If you are expressing interest please include your details in this section. If you are suggesting someone else please include their details here. First name Surname Postal address Email Contact number Do not put spaces between numbers example: 0211214028 Which Local Advisory Committee is the expression of interest for? Northland Auckland Waikato Bay of Plenty Tairāwhiti Hawke's Bay Taranaki Whanganui/Manawatū Wellington Chatham Islands Nelson Tasman Marlborough Canterbury West Coast Otago Southland How did you hear about this opportunity? Newspaper ad Word-of mouth Email/letter Social media Radio Other Were you already aware of Local Advisory Committees? Yes No SECTION 2 - Suggestor's personal details Your name Your organisation Your email Your contact number You must enable JavaScript to submit this form
