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1)
Family Name:



Given Names - Title - Ms Mrs Mr or other (please specify):



Date of Birth (eg: 25|09|2006):



Country of Birth:



Home Address:



Postal Address (if different from home address):



Telephone (home) or (work):



Occupation|Usual Major Activity:

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2)
Please indicate your reasons for wanting to join the Advisiory Council:

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3)
Please describe broadly your viewing, listening and accessing patterns for ABC television, radio and online services:

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4)
Are there any types of ABC programs in which you have a special interest (for example, youth, science, arts, children's)? Please describe:

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5)
Please describe broadly your viewing, listening and accessing patterns for non-ABC television, radio and online services:

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6)
Please describe areas, if any, where you feel the ABC has been particularly successful in reaching out to the community, or where it has failed to reach out:

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7)
Please give details of any involvement you have with community groups or organisations:

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8)
Please describe any other contacts you have with sections of the community on a day-to-day basis, for example through employment or leisure activity:

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9)
Please describe your experience, if any, in canvassing community views and needs, and representing these to interested individuals and organisations:

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10)
Please provide some insight into the personal skills you would bring to the Council:

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11)
Please provide any other information in support of your application:
 

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