Let us know you've been elected | Rep forms

A. Details

First name*

This field is required

Surname*

This field is required

Employee Number / ID*

This field is required

Email address

Email address*

Please enter a valid email address

This field is required

This type of email address is internal to LBG and cannot be used externally. Please provide an external email address.

Phone Number

Phone number*

Please enter a valid phone number

B. Workplace

Employer

This field is required

Workplace address*

This field is required

Start typing your address Enter address manually

Contact address Change address

Address line 1*

This field is required

Address line 2

Town*

This field is required

County

Postcode*

This field is required

Have you been a rep before?*

Yes

No

This field is required

C. Election details

Proposer name*

This field is required

Proposer employee no*

This field is required

Seconder name*

This field is required

Seconder employee no*

This field is required

Elected role*

This field is required

Accord representative election form