Foundation Doctor Representative Application

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Please complete ALL questions in ALL four sections before submitting the form to apply for the role of regional representative on ASiT Council.
Details of the role can be found on the ASiT website (www.asit.org).
Please read the instructions carefully, any applications that do not comply will not be considered.
DEADLINE: 30th July 2022

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Which foundation region are you applying from? *

East Anglia

Essex, Bedford, Hertfordshire

Ireland

Leicestershire, Northamptonshire, Rutland

London - NCE

London - NW

North West England

Northern

Northern Ireland

Oxford

Peninsula

Scotland - East

Scotland - North

Scotland - South East

Scotland - West

Severn

South Thames

Trent

Wales

Wessex

West Midlands - Central

West Midlands - South

West Midlands - North

Yorkshire & Humber - North

Yorkshire & Humber - West

Yorkshire & Humber - South

Background Details:

Please note you must be a paying ASiT member and at the level of FY1 or above (or due to start FY1 in August 2022) in order to be eligible to apply.

ASiT Membership Number: *

Full name: *

Grade starting August 2022: *

Email address: *

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