1. Surname

2. Forename

3. Gender

4. Where in the UK do you principally practice?

5. Present Grade/Job Title

6. Year of Membership/Fellowship of RCSEd

7. What is your specialty?

8. Do you hold a Certificate of Eligibility for Specialist Registration (CESR)?

9. Do you wish to remain in your current grade throughout your career?

10. What age do you plan to retire?

11. Are you able to access all the training that you feel you need to develop professionally?

12. Any other comments you wish to make?