Nomination for the Local Land Services Departmental Committee

Nomination for Delegate

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* 1. I nominate for the position of delegate in the following electorate:

Electorate 1 - Western (two delegates to be elected)
Incorporating Western and Central LLS Regions

Electorate 2 - Southern (two delegates to be elected)
Incorporating Riverina, Murray and South East LLS Regions

Electorate 3 - Eastern (two delegates to be elected)
Incorporating Central Tablelands, Hunter and Greater Sydney LLS Regions

Electorate 4 - Northern (two delegates to be elected)
Incorporating North Coast, Northern Tablelands and North West LLS Regions

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* 2. We, the undersigned financial members of the above group electorate, nominate:

Candidate's First name

Candidate's Surname

Phone Number

Membership Number

Candidate's residential postal address

Candidate's email

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* 3. Each nomination must be endorsed by two financial members of the above group electorate.
Please note the nominator and seconder will be sent an email acknowledging their support of the candidate.

Nominator's Membership Number

Nominator's First name

Nominator's Surname

Nominator's email address

Seconder's Membership Number

Seconder's First name

Seconder's Surname

Seconder's email address

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* 4. Candidate information: If there is a ballot, candidates who wish to have a profile uploaded to the election site should provide a brief statement of 300 words or less stating how they will best represent members’ interests. Candidates may also submit a photo (headshot less than 5 MB). Photos can be emailed to elections@psa.asn.au once a ballot has been declared.
Candidate information should be completed below:

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* 5. In the event of a ballot, do you want to be provided with a copy of the roll?
Please note: You will be required to complete a privacy form before a roll is supplied.

Yes

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* 6. RECEIPT: Acknowledgement of the receipt of your nomination form will be sent to you.

Do you consent to the nomination?

Yes

Nomination for the Local Land Services Departmental Committee

Nomination for Delegate

Question Title

* 1. I nominate for the position of delegate in the following electorate:

Question Title

* 2. We, the undersigned financial members of the above group electorate, nominate:

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* 3. Each nomination must be endorsed by two financial members of the above group electorate. Please note the nominator and seconder will be sent an email acknowledging their support of the candidate.

Question Title

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* 5. In the event of a ballot, do you want to be provided with a copy of the roll?Please note: You will be required to complete a privacy form before a roll is supplied.

Question Title

* 6. RECEIPT: Acknowledgement of the receipt of your nomination form will be sent to you.Do you consent to the nomination?

* 3. Each nomination must be endorsed by two financial members of the above group electorate.
Please note the nominator and seconder will be sent an email acknowledging their support of the candidate.

* 5. In the event of a ballot, do you want to be provided with a copy of the roll?
Please note: You will be required to complete a privacy form before a roll is supplied.

* 6. RECEIPT: Acknowledgement of the receipt of your nomination form will be sent to you.

Do you consent to the nomination?