Medical Representative Nomination "*" indicates required fields I hereby proposeName* First Last Qualifications/Posts*Address Street Address Address Line 2 City County Post Code Email* Mobile Work Telephone for nomination as a PCCS Medical Representative.Proposer* First Last Seconder* First Last Nominee, proposer and seconder MUST be members of PCCS for no less than one year. Please give a short description of your current post and interests in 50 words or less:Please give a short description of your current post and interests in 50 words or less:I hereby accept nomination to the Council.Signature of NomineePlease type your name. Date DD slash MM slash YYYY Please submit this form so that it is received by 1st November 2024CAPTCHA
