Health and Safety Conference Delegate nomination form

Details: Published: 18 September 2026

Nomination for Delegate to the Health and Safety Conference

Forms must be submitted by: 2pm Wednesday 14 October 2026

After submission you'll receive an email confirming the details of your Branch nomination.

Please check your spam/junk folder if this is not in your inbox.

Form 1a: Health and Safety Delegate Return

The following Branch Health and Safety representative has been nominated to attend the Annual NIPSA Health and Safety Conference on

Friday 23 October 2026 at the Clayton Hotel, Belfast

Please note completed nomination forms must be submitted by 2pm on Wednesday 14th October

Branch Number(*)

Required field

Telephone number:(*)

Enter your telephone number

Email(*)

Please provide an email address

signed(*)

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Office held in Branch(*)

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On(*)

Enter date and time of meeting

Delegate 1 Name:(*)

Required field

Telephone number:(*)

Enter delegate telephone number

Email(*)

Please provide an email address

Address(*)

Required field

Add another delegate?

Yes

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Delegate 2 Name:(*)

Required field

Telephone number:(*)

Enter delegate telephone number

Email(*)

Please provide an email address

Facilities for people with a disability: Clayton Hotel, Belfast is accessible to people with disabilities please specify any accessibility requirements below:

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Dietary Requirements: If you have any special dietary requirements, please specify below:

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Tick the box to submit the form