ࡱ> =?<  bjbjss *$ $ $1GGGG"""Y[[[[[[Pr[Q""QQ[GGpQRGGYQYG0{IE0">`,$"""[["""QQQQ""""""""" :  Somerset Local Medical Committee iGPCC Board Election 2011 Nomination Form Practice Manager Please return this form by no later than Noon on Tuesday 19th April 2011 I wish to nominate the following Practice Manager as a Candidate to be the Delegate for Somerset on the interim Somerset GP Commissioning Consortium Board Date ............................................................ CANDIDATES NAME ....................................................................................................................... (Block letters please) Practice Name ............................................................................................................................................ Correspondence Address ...................................................................................................................................................................... . Preferred Email.. Postcode ........................................ Signed by Proposer ................................................. Name in block letters ................................................ Signed by Seconder ................................................ Name in block letters ................................................ TO BE COMPLETED BY THE CANDIDATE (If not the proposer) If elected, I am prepared to accept office. Signed by Candidate ................................................. You can return this form by folding it and posting to the address below, by fax to 01823 338561, or as an email attached .tif or .pdf document to  HYPERLINK "mailto:lmcoffice@somerset.nhs.uk" lmcoffice@somerset.nhs.uk. If you use the latter two options please make sure that you keep the original form in case verification is required. Please ensure you also return the attached electoral statement form. Jill Hellens Returning Officer, iGPCC Election Somerset Local Medical Committee Crown Medical Centre Venture Way Taunton TA2 8QY Somerset Local Medical Committee iGPCC Election 2011 Electoral Statement by Candidate The voting papers distributed to electors in each federation will list the candidates and identify their practice. There is also space for an electoral statement of up to 300 words in which candidates can mention their relevant experience, commissioning philosophy, expectations and objectives for the iGPCC, or any other relevant matter. 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