Nomination to Council Application Form | Society for Reproduction and Fertility

Title *

First Name *

Last Name *

Email Address *

Phone Number *

Affiliation *

Current Membership Status *

Please provide the names of the two statutory members who have agreed to support your nomination *

I am willing to stand for election to the Council of the Society for Reproduction and Fertility to serve from 4 January 2019 for 4 years. I understand that, if elected, I will be a Statutory Member of the Society for at least the duration of my service on Council and will therefore waive any rights to apply for awards or grants, under the current constitution. *

I agree

Please provide a short statement (200 – 250 words) in the box below giving details of your relevant and experience and what your goals and aspirations are for your time on Council. *