LCGB Secretary Trustee Application Form Please fill out the below application, alternatively please scroll to the bottom of the page and click the button to download a 'paper' copy to email in. If you would like assistance in completing this form please contact info@lcgb.org Applications accepted up until 5pm, Monday 20th June 2022Date(Required) Day Month Year Name(Required) First Last Address(Required) Street Address Address Line 2 City County Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) PhoneSocial media presence(Required)Are you currently certified as an IBCLC?(Required) Yes No Retired When did you retire from your IBCLC qualification?(Required) Do you intend to sit the IBCLC Exam?(Required) Yes No When do you intened to sit the IBCLC exam?(Required) Please list any additional professional qualifications you hold(Required)Please describe your experience in administrative/secretarial roles(Required)300 words maxPlease describe your experience in other advocacy groups – voluntary or professional(Required)300 words maxBriefly describe your current work, any clinical practice and your workplace setting for each role.(Required)300 words maxGive examples of how you would ensure EDI is a focus within your work as a trustee? Draw on your personal and professional experience and interests.(Required)300 words maxGovernance responsibilities and board roles.Briefly describe any additional skills, experience, previous charity or board work, or additional credentials that support working as a trustee at a strategic level with governance responsibility.(Required)300 words maxBriefly describe what you could offer LCGB as a trustee.(Required)300 words maxWhat motivates you to become a trustee?(Required)300 words maxPlease include details of two referees stating their relationship to you and how long they have known you. Referees will only be contacted if you are offered the role.Name First Last Referee #1 PhoneReferee #1 Email Referee #1 Date known since Day Month Year Approximately Referee #1Name First Last Referee #2PhoneReferee #2Email Referee #2Date known since Day Month Year Approximately Referee #2 Please fill out the above application, alternatively please click the button to download a 'paper' copy to send in.Click to downoad