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* 1. Full name

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* 2. Email address

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* 3. Town/City/County

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* 4. Are you a Fellow (previously called full member) of the BSSH?

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* 5. Which year did you become a Member of BSSH?

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* 6. Plastic or Orthopaedic Specialty?

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* 7. Have you had any Committee or Council roles within the BSSH? Please list with dates.

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* 8. What experience do you have chairing committees?

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* 9. Do you have financial, publishing, editing or business experience that you feel is transferable to this role? If so, please tell us about it.

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* 10. Please describe any other skills you have that would be beneficial to Committee of Management.

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* 11. Do you have the time available for this commitment?
Please list any known significant commitments during 2027 – 2031 (with dates) – e.g. clinical/medical director, other roles with BAPRAS/BOA/BSSH
N.B we envisage that this role will require a time commitment of 2-3 hours a week.

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