Please ensure you have read the role description and terms of reference before completing this form.
To apply for election to the PCRS Executive, please complete this form by midnight on Sunday 22 November 2020. Please also secure the support of two fellow PCRS formal members to endorse your application. Details of your application, including your professional status and the supporting information you provide below, will be provided to members to inform them of candidate profiles in the event of an election of the membership.
Please list below the names of two PCRS formal members who are willing to endorse your application (you must seek their permission before completing this form).
Please indicate what interests, if any, you have in any of the following with respect to income/earnings, fees, or other payments you receive.
This section allows you to add information in support of your application.
Please review and check the boxes below after you have read the supporting information and provided that you meet the criteria for the declaration.
If you are a practising healthcare professional working in primary care in the UK, provided you are not employed by a pharmaceutical company or associated agency and have no connection with the tobacco industry, you may apply to become a "voting member" (sometimes referred to as "formal" or "company" membership) of the PCRS. In addition to the benefits enjoyed by all other members, "voting" members have a "say" in the business of the organisation and, for example, are responsible for electing the members of the PCRS Executive and the trustees as well as voting on motions at the annual general meeting (AGM). If you have completed the declaration, you are a formal member. You can check if you are a formal member on the Manage your details page.