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The closing date for applications is 23:59, Monday, 31 January 2022.

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* 1. Your name

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* 2. Your institution/hospital

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* 3. Your email address

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* 4. Survey title

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* 5. Purpose of the survey, and its potential benefit to the membership

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* 6. Relevance of the survey topic to the needs of patients and/or the NHS

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* 7. Justification that the survey is necessary to answer the question/s posed, i.e., such information is not available by other means

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* 8. Confirmation of how the results of the survey will be utilised

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* 9. Plans for dissemination of survey results.

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* 10. Use this space to include a link to your proposed survey (not necessary but useful)

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