E-AHPBA are seeking new committee members who are enthusiastic, committed and have the time, experience and qualities required to make a difference to the Association.  If you feel that you have something to contribute please complete the form below. 
The deadline for submission is Tuesday 18th December 2018.

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* 1. Please provide the following information:

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* 2. Please provide your date of birth:

Format DD/MM/YYYY:

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* 3. Please advise your Gender:

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* 4. How long have you been a member of E-AHPBA:

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* 5. Please advise the committee you would like to serve on:

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* 6. Please detail your qualifications and qualities which you consider relevant in fulfilling this role:
(For example past council or committee work, publishing, social media skills, key links with industry, educational leadership, research strategy, conference organisation, charitable/philanthropic activity, goverance, audit roles, leadership roles in surgery):

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* 7. Please detail any similar roles or relevant experience within other organisations:

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* 8. Please detail any other supporting information:

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* 9. Please upload your CV:

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* 10. Please give the name of an E-AHPBA member who will provide a letter of support:

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* 11. If available please upload  the letter of support:

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