Blind Low Vision NZ Ambassador Expression of Interest

Name

First Name

Last Name

Phone Number

Email

Your region

Your Story – What is your lived experience with vision loss?
Please provide a short video/audio file telling us about your story (no longer than 3mins)

I have read and agree to the Blind LowVision NZ Code of Conduct

Yes

* In submitting my expression of interest form, I acknowledge that Blind Low Vision NZ will follow due process in reviewing my expression of interest and making final decision on my acceptance into the programme as a Blind Low Vision NZ Ambassador. Furthermore, if accepted, I consent for my image and story to be used in promoting the Ambassador Programme.