Your name Your email address Your contact number Position title (if applicable) Postal address Why do you want to be on City of Darwin’s Access and Inclusion Advisory Committee? Please include any personal connection, passion, or lived experience that informs your interest. What background, skills, expertise, and knowledge will you bring to the Access and Inclusion Advisory Committee? This may include professional qualifications, community involvement, advocacy work, or personal and/or family experience with disability. Do you have any access requirements for attending the meeting or for receiving electronic communications? Are you able to attend the following meeting in 2025? 6 November Note: It is a requirement for members to be able to attend these meetings as a quorum is necessary for all meetings. Meetings are from 1.30 pm to 3.00 pm at Casuarina Library. I hereby apply for membership on City of Darwin’s Access and Inclusion Advisory Committee for appointment for a 1-year term for 2025 to 2026. Sign above Privacy Statement City of Darwin will comply with the Information Privacy Principles contained in the Northern Territory Information Act. These principles protect the privacy of personal information collected and held by the Council. The Council’s Privacy Policy explains how personal information is collected, used, and stored. It also details how you can access your personal information. Council’s privacy statement is available from the City of Darwin, Harry Chan Avenue, Darwin or via the City of Darwin Privacy Statement.