• The information contained in this form is true in all respects
• I am aware of the duties and obligations of becoming a member of the Board of MHF ACT
• I am not ineligible to stand for election under the terms of the Constitution of MHF or the Corporations Act 2001 (Cth).
• I am not aware of any conflicts of interest that would prevent me from accepting a position on the Board
• I accept that this is my electronic signature.