EmailMeForm
NODE NEWS | HP MEMBER PROFILE | SPOTLIGHT
Lymphoedema Association of QLD Inc. ABN: 13 602 257 202
Please complete this form so your profile can be published in Node News
Your name:
First
Last
Name of your business:
Website address of business:
Email address of business:
This email will be published in Node News
Business - Mobile phone number:
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This phone number will be published in Node News
Business Land line phone: (If applicable)
This phone number will be published in Node News
Confirm Your LAQ Membership Type:
Committee Member
Health Professional Member
Do you have Lymphoedema?
YES
NO
If you ticked YES | Please describe what type of Lymphoedema you have, your Lymphoedema journey, and how you manage your condition.
Please describe why you decided to become a LAQ Member and value you have found from being a Member?
ABOUT YOUR BUSINESS/CAREER - Please provide a brief description and background.
ABOUT YOU - Please provide a brief description of your personal background, your interests and what inspires you.
YOUR (3) TIPS - As part of your profile please provide 3 tips those with lymphoedema might find helpful.
File Upload: (Send Your Photo)
Add File
Please upload the photo you want displayed with your profile on LAQ's website. NOTE: The maximum size of the file you upload here CANNOT exceed 10MB.
I agree for the above information and my image to be published in Node News media and utilised by LAQ across their online and social media communications channels.
*
YES - I give my approval
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Thank you for your submission. Before clicking the SUBMIT button please ensure that you have proofread the text you have entered for your Profile to ensure it is all correct.
To send your submission simply click on the SUBMIT button below.
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Lymphoedema Association of Queensland Inc.