Community Advisory Group Expression of Interest - Australian Breakthrough Cancer Study

First Name *

Last Name*

Date of Birth*

Email address*

Why are you interested in participating in the Community Advisory Group?*

Examples of the types of activities you might like to do include:

Representing diverse perspectives in the development of research questions
Providing feedback on research communications (e.g., letters, emails, newsletters)
Testing or reviewing research surveys and questionnaires
Sharing your thoughts on study priorities and participant experience
Participating in online discussions or workshops

Are you currently involved with Cancer Council in any other way? (e.g., peer support groups, fundraising, attended workshops etc.) *

Yes
No

Please specify how are you currently involved with Cancer Council?

Do you have relevant experience you would like to share?*

Examples of experience you might have could include:

Is there anything else you’d like to share about your background, experience, or what you’d bring to the group?

Are you of Aboriginal or Torres Strait Islander origin?*

Were you born overseas? *

Yes
No
Prefer not to answer

Please specify where you were born

Are you living with a disability? (i.e. sensory impairment, mobility impairment, learning disability, or other)*

Yes
No
Prefer not to answer

Please specify the disability

Do you identify as LGBTQI+? *

Yes
No
Prefer not to answer

Please specify

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