Forename: Click or tap here to enter name.

Surname: Click or tap here to enter name.

Nomination for:	Choose the type of appointment.

Nominated by: Click or tap here to enter the name of the nominating member.

Candidate Statement

Click or tap here to enter text.

Confirmation of Nomination

I confirm that I have read the detailed role descriptor for the role for which I am being nominated and am willing to stand for election and carry out the specified duties of the role if appointed.

Signature: