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 Friday 21 October 2022CAPTCHA
