Medical Representative Nomination

"*" indicates required fields

I hereby propose


for nomination as a PCCS Medical Representative.


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:

I hereby accept nomination to the Council.

Please type your name.
DD slash MM slash YYYY
Please submit this form so that it is received by Friday 21 October 2022