RCN Agenda Committee election 2013

Nomination form

Please fill in the form below and press submit. You will need details of your nominator and supporters, so make sure you have this information before starting the form as unfortunately progress cannot be saved.

Before completing this form you must refer to the election procedure for this committee.

We will acknowledge all nominations by email within seven days. If you do not receive an acknowledgement, please contact us at stephanie.wilson@rcn.org.uk

All online forms must be received no later than 2.00pm on Tuesday 23 April 2013.

Part one: details of nominee First name(s):
Last name:
RCN membership number:

Phone number while at Congress:

Email address:
Attended Congress in which years? (hold down "ctrl" to select all that apply):

Part two: details of nominator

Nominations must be signed by one nominator and two supporters, who must be registered voting members for RCN Congress 2013, from any three of the following submitting entities: Branches, Forums, RCN Students Committee, RCN Health Practitioner Committee, UK Stewards Committee, UK Safety Representatives Committee, UK Learning Representatives Committee.

First name(s):
Last name:
RCN membership number:

Phone number while at Congress

I am a voting member of:

Part three: details of supporters

Nominations must be signed by one nominator and two supporters, who must be registered voting members for RCN Congress 2013, from any three of the following submitting entities: Branches, Forums, RCN Students Committee, RCN Health Practitioner Committee, UK Stewards Committee, UK Safety Representatives Committee, UK Learning Representatives Committee.

First supporter:

Branch/Forum/Committee:

First name(s):
Last name:
Phone number while at Congress

Second supporter:

Branch/Forum/Committee:
First name(s):
Last name:
Phone number while at Congress

Part four: candidate information

We want to know more about you. Please answer the questions below, demonstrating how your qualities and experience will help you fulfil your role as an Agenda Committee member. You should try and address the following questions: