Application Form
 West Midlands Rural Affairs Forum |
Nomination for Membership
Representative on behalf of: | |
| For the period of (term of mandate): | |
| Details of Full Member |
| Name: | |
| Title: | |
| Organisation: | |
| Correspondence Address: | |
| Telephone Number | |
| Email Address | |
| Details of Deputy |
| Name: | |
| Title: | |
| Correspondence Address: | |
| Telephone Number: | |
| Email Address: | |
| Please note that the nominated Alternate member will be expected to attend every meeting which the Full member is unable to attend. |
Please complete form and return via post, fax or via email to:
Rebecca Mackay,
c/o Sustainability and Rural Affairs Team
Government Office for the West Midlands,
5 St Philip’s Place,
Colmore Row,
Birmingham
B3 2PW
Tel: 0121 352 5371 Fax: 0121 352 5335
E-mail: rebecca.mackay@gowm.gsi.gov.uk