17 Clifton Road, Birmingham, B12 8SX
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President's Surgery

Version 3.1


  • This form should be used if you are booking an appointment to meet the President during his surgery.
  • Please answer all questions. If you are unsure of the answer to any question or you do not think it applies to you, please indicate this on the form.

I, * would like to have an appointment for the President's Surgery

My Email address is

My Telephone/Mobile number is *