<p> Australian Council of Social Service Locked Bag 4777 Strawberry Hills NSW 2012 Tel: 02 9310 6200 Email: [email protected]</p><p>ACOSS BOARD OF DIRECTORS NOMINATION FORM: National Constituency Organisation Member</p><p>Nominating National Constituency Organisation Member ______</p><p>Nominee Details Name ______Address ______Work ______Mob ______Email ______</p><p>1. Candidate Statement (to be provided in voting material) (200 Word Limit)</p><p>2. Nominating Organisation’s Statement (to be provided in voting material) (200 word limit)</p><p>I (Nominee) ______(Signature) ______Agree to this nomination.</p><p>Contact officer for nominating National Constituency Organisation Member Name ______Signature______Email ______Phone______</p><p>APPLICATIONS MUST BE RECEIVED AT THE ACOSS OFFICE BY 13TH OCTOBER 2017</p><p>Office use only: Date received ______Membership checked  yes</p>