RADF Committee Nomination Form

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Title
First name
Surname
Street Address
Suburb / Town
State
Postcode
Postal address
Suburb / Town
State
Postcode
Work phone
Home
Mobile
Fax
Email
Website address
Please indicate if you represent one or more of these group	Aboriginal people Torres Strait Islanders Councillor Female Male Older persons (55 years +) People with a disability Young people (under 26) Culturallly and linguistically diverse
Have you previously been a RADF Committee member with Mackay Regional Council and/or with another council?	Yes No
If yes, on which council were you previously a RADF Committee member?
Tell us why you would like to join the Mackay Regional Council RADF Committee?
Please indicate the artforms you have expertise in (please tick all relevant boxes)	Visual Arts Craft Design Theatre Writing Multimedia Dance Music Museums and Cultural Heritage Festivals Community Cultural Development
Are you a member of any arts and cultural organisations and/or collectives? If so please list your memberships status (e.g. Arts Workers Alliance, general member)
Have you attached your current resume/CV and letters of support from organisations/collectives you are a member of (Please zip up all files in a folder and the file size must be less than 2MB)
Certification I have read and I understand the roles and responsibilities of a RADF Committee member. The statements in this nomination form, are true and correct to the best of my knowledge, information and supporting material are my own work. I give permission for council to verify statements outlined on this form.	Yes No

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