Your Voice in the Media

The IMO Communications unit is seeking members of the organisation to promote our policies in the media. If you are willing to act as a media spokesperson and patient advocate on specialist topics please complete this form with your details.

Name: *

IMO Membership No:

County:

Are you a:	GP	Consultant
	Community Health Doctor	NCHD
	Public Health Doctor	Other

Speciality:

Health in the Media:
Patient advocacy, medico-politics, health service funding and management of the health service are the key areas of health in the media. Please indicate specialist topics of interest to you.

Email Address: *

Mobile No: *

Work No:

An bhfuil Gaeilge agat? Would you be confident to speak in Irish for a media interview?
Yes	No

Do you have media experience?
Yes	No
If yes please outline in detail:

Would you like to receive media training?
Yes	No

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