First name
Last name
Email
Mobile
1.
How are you connected to Lyne?
2.
How do you align with issues of importance to the people and communities of Lyne?
3.
Why are you considering running as a candidate for Federal parliament?
4.
Why is running as an *independent* candidate important to you?
5.
What skills and experience can you bring to the role?
6.
If successful, how will you change the way Lyne is represented in the Federal Parliament?
7.
Who is your source of inspiration and/or role model, and how have they shaped you and your way of approaching the world?
8.
Do you have previous or current political affiliations or memberships?
9.
Do you comply with the eligibility requirements set out by the AEC?
Please select
Yes
No
10.
Are you willing to share with the selection panel any potentially controversial history or views?
Please select
Yes
No
11.
Age
Please select
18-27
28-37
38-47
48-57
58-67
68+
12.
What area do you live in?
Please select
Port Macquarie-Hastings
Greater Taree
Great Lakes
Dungog
Gloucester
Port Stephens
Maitland
13.
Contact Availability