Nomination form for the post of President-Elect of the RSUA for the year 2021/22

Question Title

* I confirm that I am willing, if elected, to serve on RSUA Council as President-Elect during the 2021/22 year and as President during the 2022/23 and 2023/24 years.

I confirm

Question Title

* Contact Details

Name of candidate

Address Line 1

Address line 2

City/Town

County

Postal Code

Country

Email Address

Phone Number

Question Title

* Date of birth

Please tell us your date of birth.

Date

Question Title

* Honours, Degrees, Affixes

Question Title

* Name and address of organisations where currently employed

Question Title

* This nomination is supported by the following 15 members of the Society

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15

Question Title

* I confirm that the chartered members listed above have agreed to support my nomination.

I confirm