Position for which Candidate is Nominated:......................................................................
Candidate details:
Name: ......................................................................
Address:................................................................................................................................
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Telephone: ..............................................................
Fax: .........................................................................
Email: ..................................................................................................................................
Signature of Candidate: .........................................
Date: ...........................
Nominator 1:
Name: ......................................................................
Address:................................................................................................................................
..............................................................................................................................................
Telephone: ..............................................................
Fax: .........................................................................
Email: ..................................................................................................................................
Signature of Nominator1: ......................................
Date: ...........................
Nominator 2:
Name: ......................................................................
Address:................................................................................................................................
..............................................................................................................................................
Telephone: ..............................................................
Fax: .........................................................................
Email: ..................................................................................................................................
Signature of Nominator 2: .....................................
Date: ...........................