Completed forms should be returned by email: or by post: Maxine Adrian-Fleet, NICE, Level 1A, Piccadilly Plaza, Manchester, M1 4BD. Contact details Full name: (including title) Job title: Department / service area Organisation: Email address: Tel number(s): Additional information: (e.g. Secretary/PA contact details) I understand that as a panel member, I may be invited to contribute to the development of support resources relating to the following NICE work streams. I have ticked below, those that are of particular interest to me: Adoption of technology Implementation of guidelines/ guidance Resource impact assessment (costing, commissioning) Uptake of guidelines/ guidance
Completed forms should be returned by email: or by post: Maxine Adrian-Fleet, NICE, Level 1A, Piccadilly Plaza, Manchester, M1 4BD. Contact details Full name: (including title) Job title: Department / service area Organisation: Email address: Tel number(s): Additional information: (e.g. Secretary/PA contact details) I understand that as a panel member, I may be invited to contribute to the development of support resources relating to the following NICE work streams. I have ticked below, those that are of particular interest to me: Adoption of technology Implementation of guidelines/ guidance Resource impact assessment (costing, commissioning) Uptake of guidelines/ guidance
Adoption-impact-ref-panel-app-form.docx