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Election of RSUA Council 2021 Nomination Form

Nominee Details

Nominations are to be completed by no later than 5pm on Friday 23 April 2021.  Nominees are invited to supply a voluntary statement of no more than 50 words which will be published with the voting papers should an election be required.  Whether you are nominating yourself or another member, please provide the following nominee details. Existing Council members who wish to stand again should complete this form.
 
 
1.Nominee name(Required.)
2.Nominee email(Required.)
3.Nominee phone number(Required.)
4.Name & location of practice, office, school or department in which the nominee works
5.Position held by nominee
6.Nominee's previous involvement in RSUA committees etc.
7.Nominee's optional statement (no longer than 50 words)
Nominator Details

If you are nominating someone other than yourself please enter your name, email address and telephone number here. Please also ensure that the candidate has agreed that his/her name may appear on the ballot form for election.
8.Nominator name
9.Nominator email
10.Nominator telephone number
11.The nominated candidate has agreed that his/her name may appear on the ballot form.