YWCA of Canberra

Australian Council of Social Service Locked Bag 4777 Strawberry Hills NSW 2012 Tel: 02 9310 6200 Email: [email protected]

ACOSS BOARD OF DIRECTORS NOMINATION FORM: National Constituency Organisation Member

Nominating National Constituency Organisation Member ______

Nominee Details Name ______Address ______Work ______Mob ______Email ______

1. Candidate Statement (to be provided in voting material) (200 Word Limit)

2. Nominating Organisation’s Statement (to be provided in voting material) (200 word limit)

I (Nominee) ______(Signature) ______Agree to this nomination.

Contact officer for nominating National Constituency Organisation Member Name ______Signature______Email ______Phone______

APPLICATIONS MUST BE RECEIVED AT THE ACOSS OFFICE BY 13TH OCTOBER 2017

Office use only: Date received ______Membership checked  yes