<p>HUNTER WATER CONSULTATIVE FORUM NOMINATION FORM</p><p>Name of group or organisation: ______</p><p>Name of nominated representative:  Mr  Mrs  Ms Surname: ______</p><p>First Name: ______Preferred name (if different): ______</p><p>Address: ______Position within group or organisation: ______Contact number: ______Mobile: ______Fax: ______Email: ______</p><p>PLEASE COMPLETE THE FOLLOWING SECTIONS AND PROVIDE RELEVANT DOCUMENTATION:</p><p>1. Community representation Please indicate which area of the community your group/organisation represents: (you may tick more than one, if applicable):</p><p> Business or consumer group  Environmental group  Low income households  Older people  People living in rural and urban fringe area  Aboriginal group  Residential consumers  Non-English speaking backgrounds  People with disabilities</p><p>2. Gathering input If selected, how would you gather information from your local community / group in order to provide feedback to the Consultative Forum on their behalf?</p><p>3. Keeping the community informed If selected, how would you feed information back to your local community / group? E.g. do you have communications methods available (newsletters, group meetings, website etc) to enable you to disseminate information? </p><p>4. Support for your application You are encouraged to provide further information or comments to support your application. This will be important for Hunter Water to form the basis for selecting members of the Consultative Forum. For example, you may like to reinforce why you would like to become a representative, make a statement about how you are willing to contribute to the Forum or include details of areas of expertise or previous community involvement to support your nomination. </p><p>5. Availability You must be available to attend the first Consultative Forum meeting on 13 September 2012. Meetings will be held September, December, March and June each year and will be held at Hunter Water’s Honeysuckle head office in Newcastle starting at 9.30am. You must endeavour to attend all meetings, or send a substitute representative if you are unable to attend. Please include details of you substitute representative:</p><p>Name: ______Position within group or organisation: ______</p><p>6. Confirmation Please supply written documentation from your group/organisation stating their support for you as their nominee for Hunter Water’s Consultative Forum.</p><p>CLOSING DATE FOR APPLICATIONS: 31 MAY 2012</p><p>Page 2 of 3 Please return this nomination form with any relevant attachments to:</p><p>Post: Elisha Whitburn Manager Media and Government Relations Hunter Water PO Box 5171 HRMC NSW 2310</p><p>Fax: Elisha Whitburn on (02) 4925 2078</p><p>Email: [email protected]</p><p>For information on the Consultative Forum or enquiries: Call Elisha Whitburn on (02) 4979 9524 or visit www.hunterwater.com.au</p><p>Privacy information: Your privacy is important to us. Hunter Water Corporation will use personal information provided by you in accordance with the Privacy Act 1988 (Commonwealth). If successful, your name and community group/organisation will be published on the Hunter Water website, as a member of the Consultative forum. Names published are as attendees and your participation will be recorded as part of the Minutes of each Consultative Forum meeting. You acknowledge that you provide this personal information voluntarily and consent to the use of such information by Hunter Water as described above, unless otherwise agreed. </p><p>Page 3 of 3</p>