Apply to be on an FSRH Committee

We are delighted that you are interested in joining one of our FSRH Committees. Whether you bring skills gained in your professional roles or from 'team work' or committee experience in other aspects of your life - perhaps just a passion and enthusiasm - there may be a role for you. Please can you fill in your details below to submit your application (some sections are optional).

If you would like a copy of your responses (which can be useful, should you apply for other things in the future), please add your email address in the relevant field at the bottom of this form

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Personal Contact Details

Please complete your personal details in full to enable us to contact you after your have submitted your application.

Full Name*

Contact Address in Full*

Contact Telephone Number*

Contact Email Address*

About your experience and qualifications

Please give us some information about your professional experience and qualifications.

Please tells us about your Qualifications*

Tell us about your qualifications.

What is your present work role?*

What is your work role at the moment?

Tell us about your clinical activities*

Tell us about your educational activities. This is particularly relevant if applying for a position on our General Training Committee or another of our education-related committee.*

Tell us about your educational activities. This is particularly relevant if applying for a position on our General Training Committee or another of our education-related committee.

Please tell us about any involvement that you have had with research.

Please tell us about any writing for publications that you have done (or editorial roles you have had) NB these can be in your professional or personal life.

Tell us which committee and post you would like to apply for:*

Previous Committee Experience

If you have had any previous committee experience, we are very keen to know more about your role on the committee and how you contributed to the organisation by being a member of that committee.

Please tell us about any previous experience on committees (in the last five years)

Have you sat on any committees? In what capacity? Was it a leadership role? What kind of committee was it?

What was the name(s) of the organisation?

What was your role on the committee?

Were you a member/chair/co-chair of this committee? What kind of expertise did you bring to the committee?

Do you have any specialist interests?

Can you tell us anything additional about your specialist interests?

Please tell us about any publications (in the last 5 years)

Why have you applied to be on this committee? (no more than 100 words)*

Tell us why you'd like to be involved with FSRH's work as a committee member and what you see your contribution offering to FSRH.

Confirmation of Details*

If you would like a copy of your responses to this form please enter your email address below:

Verification

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Apply to be on an FSRH Committee