Customer Influence Panel Application If you need any assistance completing this form or would like it in a different format, please contact the Customer Engagement Team. Personal information Last name * First name(s) * Preferred name (if different) Title (Dr/Mr/Mrs/Miss/Ms/Other – please specify) * Address * Start typing your address in the postcode field Preferred phone number * Email address * Why would you like to join the Customer Influence Panel, and what do you hope to achieve as a member? Tell us about an experience, perspective or insight that would help you contribute to the Customer Influence Panel. How would this help you represent customers and contribute to improving services? Tell us about a time when you shared feedback, raised a concern, challenged something constructively or helped improve a situation. What did you do and what happened? Customer Influence Panel members are expected to consider the interests of all customers, not just their own experiences. How would you approach this? Tell us anything else about yourself that you think may be relevant to your application Captcha
