Special interest form

Purpose of form
Please use this form to outline your idea for a special interest network or programme of activity.
Name of 'Special Interest' request*
Background for request*
Aims and desired outcomes of the request*
Planned activities*
Menu of responses*
- New network
- Round table discussion
- Task and finish group
- Policy and campaign
- Consultation response
Is the request relevant across the membership or to a particular network?*
Network group details
Submitted on behalf of*
Name and organisation of proposer(s)*
e.g. Name, Organisation
Main contact details
Name of main proposer*
First Last
Email address of main proposer*
Enter Email Confirm Email
Organisation name of main proposer*
Statement of special interest request
We will review your submission and will be in touch in due course.

Purpose of form