Palliative Care NSW - Nomination Endorsement

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* 1. Full Name (of person providing endorsement)

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* 2. Email (of person providing endorsement)

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* 3. Contact Phone No.

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* 4. I am a current financial member of Palliative Care NSW.

I hereby endorse the nomination of the candidate (named below), who is personally known to me, for the position of Vice-President, Secretary, Treasurer or General Member

Yes

No

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* 5. Full Name of candidate

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* 6. Email address of candidate (used in their application)