Nottinghamshire LMC 2024-2027  Election Form for GP Committee Member nominations 

I declare that I am a practicing GP working in Primary Medical Services within NHS Nottingham and Nottinghamshire ICS. 

If you are standing in this election, you MUST get a GP from your Place Based Partnership (PBP) to endorse your nomination. Please ensure you have spoken to them and gained consent to share their details with us before completing your application. 

Elections open on Monday 15 January 2024 and close on Friday 1 March 2024 at 5pm. 
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Электронная почта *
Your name  *
Job title *
Practice name
 *
Which PBP area(s) do you work in?
 *
Обязательный вопрос
In no more than 300 words, please tell us about your reasons for wanting to join the LMC, including details of current roles and experience. 

N.B - If the elections go to a ballot, the information you provide will be shared with member practices as part of the voting process to allow them to make an informed decision. 
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Details of endorsing GP (please include their name, practice name and email address).

I certify that I have permission to share their details with the LMC.  *
Would you like to be signed up to our free e-updates and newsletters?  *
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