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! Reason:
| {{{field|description|mandatory|size=100}}}
|-}
{| class="formtable"
! Region:
! style="width:5em" | Region:
| style="border-style: solid; border-width: 1px; border-color: gray;width:50px" | {{{field|region|mandatory|input type=combobox|values=East Midlands,East Of England,International,London,North East,North West,Scotland,South East,South West,Steering Committee,Wales,West Midlands,Yorkshire & Humber|size=30}}}
|-
! Proposer: