Campaign to Reform NDIS

 Fulfilling the Promise to
Revolutionise Disability Services

Participation Form


I wish to participate in Reforming NDIS.

Please provide the following contact information

Name
Organisation
Tel
Email
 Address
Address 
State
Postcode


Category (you may tick more than one):

 NDIS participant
 Person with disabilitiies
 Family/carer
 Support worker
 Support coordinator
 Service manager
 Researcher
 Community organisation staff 
 Government officer
 

My federal electorate is: 

 

  I would like to act as a Campaign Coordinator in my federal electorate.

  I would like to join the Campaign Steering Committee.


I have the following skills:

 Community networking
 Media skills
 Policy writing
 Lobbying experience
 Social media skills
 Graphic design skills


Tell us about yourself and your interests:


 

I would like to participate in a Local Area Network of Peers to develop mutual supports

I would like to participate in a Circle of Support for:                                              

              

Name of your local area / local government area:

Please tell us if you have had previous experience in support networks or circles:

             
         I would like a speaker to visit our group or organisation to talk about this Campaign

 

 

[Please note: We will send a confirmation of acceptance as soon as possible:
if after submitting this form you receive an error message, please disregard it.]