Consumer Advocate Expression of Interest

We’d love to have you on board to join us in advocating for the 1 in 3 Australians living with a lung disease or lung cancer. To be involved, please complete the details below so you can join our consumer advocacy community.

Your Details

Title

First Name

Last Name

Mobile Phone

Street Address

Suburb

State

Postcode

Why would you like to be a Lung Foundation Australia (LFA) Lung Health Advocate? (255 characters or less)

Can you please describe any advocacy experience that you have and what you are passionate about advocating for with LFA. (255 characters or less)

When I am advocating, I will do so as a:

PatientCarerCommunity MemberHealth ProfessionalResearcherOther

Other:

Condition

Alpha1 Antitrypsin DeficiencyAsbestosisAsthmaBronchiectasischILDCOPDIdiopathic Pulmonary FibrosisInterstitial Lung DiseaseLung CancerMesotheliomaNontuberculous mycobacteria (NTM)Paediatric Lung Disease PneumoniaPulmonary Arterial HypertensionPulmonary FibrosisPulmonary HypertensionSarcoidosisSilicosisTuberculosisOther

Condition: Other

Health Professional Type

Allied Health- ExerciseAllied Health- OtherAllied Health- PharmacyDoctor – GPDoctor- SpecialistNurseOtherResearcher

Health Professional Type other

Special Interest Area

BronchiectasisCOPDExerciseIdiopathic Pulmonary FibrosisLung/Thoracic CancerOccupational Lung DiseasePaediatric Lung DiseasePalliative CarePulmonary Arterial HypertensionPulmonary FibrosisPulmonary HypertensionRare Lung DiseaseRespiratory and sleepOther

Special Interest Area other

A little bit you:

I identify as...

Aboriginal	Torres Strait Islander
Aboriginal and Torres Strait Islander	Neither Aboriginal nor Torres Strait Islander

At home, I speak a first language other than English

NoYes

Which language do you speak?

My advocacy experience and interests

I would describe my advocacy experience as...

I’m new I’ve done some here and there but not too much I’ve done some in the past I’m a pro I’m unsure

Advocacy can take place in many ways. We'd love to know what experiences you have (these are in general and may not relate to why you are joining the Lung Foundation Australia advocacy program). Please select all that apply.

Sharing your story on tv Providing a quote/sharing your story in a newspaper or article Sharing your story on the radio Writing to a Member of Parliament (email or letter is fine) Meeting with a Member of Parliament in my community Meeting with a Member of Parliament at their office Writing a formal submission NoneOther

Other (please specify)

I would like to be involved in advocating for the following. (Please select all that apply)

Access to medicines and devices Better lung health for all Australians Preventing lung disease (e.g., vaping, smoking, air quality, climate change) Research investment Chronic Obstructive Pulmonary Disease (emphysema) COVID/Long COVID Lung cancer (e.g., improved access to services, nurses, screening expansion to all Australians) Occupational lung disease (e.g., silicosis) Improved access to services, support, treatment options for your condition Pneumonia (including immunisation) Alpha1 Antitrypsin Deficiency Asbestosis Bronchiectasis chILD Idiopathic Pulmonary Fibrosis Interstitial Lung Disease Mesothelioma Paediatric Lung Disease Pulmonary Arterial Hypertension Pulmonary Fibrosis Pulmonary Hypertension Sarcoidosis Other

Please specify

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