About you

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* 1. Please enter your name, contact details and GPhC/PSNI registration number

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* 2. Which region do you work in?

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* 3. On what basis do you work at Boots?

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* 4. Do you work in the bargaining unit of registered and pre-registration store-based pharmacists at levels 5, 6 and 7 who are employed by Boots Management Services Ltd?

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* 5. Are you a PDAU member?

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* 6. Please tell us why you would like to become a PDA Union Representative

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* 7. If you become a Union Representative, how far would you be prepared to travel from your home location to attend a meeting or undertake union activity?

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* 8. What contribution would you like to make to the union's activity (check all that apply)

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* 9. Please tell us about what previous involvement you have had with the PDAU (1500 characters max)

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* 10. Please tell us about any other trade union experience you have (1500 characters max)

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* 11. Please tell us about any previous experience of helping fellow pharmacists (1500 characters max)

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