Become a Consumer Representative

Consumer Representative Expression of Interest (EOI)

We value the ability to work with, and better understand, our community. You are invited to submit an EOI and will be warmly welcomed to be a representative for the community at Stawell Regional Health.

Please register your interest and availability by completing this form:

EOI Consumer Representative

Complete this form to register your interest to become a consumer representative with Stawell Regional Health.

    Please select your age range with a clicking in the box.
  • Please provide your mobile phone number
  • Please provide your email address
    Indicate your preferences for receiving contact and any mail
    To ensure we meet the needs of specific projects, do you identify with any of the following groups?
  • Please specify language
  • I am a member of the following Community Associations / Community Interest Groups / Local Recreational or Support Groups
  • Please provide an indication of the health topics you are interested in.
  • Please briefly provide details of your personal and job skills and expertise below:
  • Please indicate which of the activities you would be interested in - Hold CTRL to select more than one option
  • Please indicate if you are available in the evenings, weekends or business hours - Hold CTRL to select more than one option.