Hepatitis Council of NSW

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Please provide the following details about the requested session. This information will enable us to tailor the session to your needs.

Upon completion, please press 'email form' at the bottom to send this form back. You will be contacted with confirmation asap.

Please be aware that our education sessions are free. Ceen & Heard speaker services are free to members of the HCCNSW and NSW NGOs. Please contact the council for information on membership otherwise, there is an $93.50 fee (GST incl) payable for the speaker.

Thank you

Service Information

Service Name   

Contact Person   

Phone          Fax   


Postal Address   


Session Requested

Type of Session:

   C-een & Heard speaker only

   Educational session only

   Both a C-een & Heard speaker and an eductional session


Session Details

Date     Start Time      Finish Time  

Workshop Address/location/room number   

Room Size (seating capacity)

Facilities available (eg. OHP, whiteboard, dataprojector)   

Expected number of participants   


Participants Needs

Outline of jobs/roles of participants

Reason for requesting this session


Speaker Session Content

C-een & Heard speakers are men and women of various ages and diverse background who talk about their personal experiences of hepatitis C.

Would your audience like to hear from a speaker with particular experiences or characteristics.

   Yes         No     

Special Characteristics   

Are there particular issues or topics that your audience would like to hear about (eg. discrimination)?

   Yes         No    



Briefing for Speaker

Please indicate below any briefing notes that may be of assistance to the speaker (eg. audience attitudes, interests, etc.)


Education Session Content

Are there any particular issues or topics that your audience would like to be included in an education session (eg. injecting drug use, hepatitis C treatment, etc.)