CANDIDATE INFORMATION

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* 1. What is your name (including preferred title)?

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* 2. What is your Actuarial Reference Number (ARN)?

Note: This is for identification purposes only

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* 3. What is your preferred contact email address?

Note: this may be shared with Council members so that they can contact you about your nomination

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* 4. What is your preferred contact telephone number?

Note: this is requested for election administrative purposes only

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* 5. Which constituency are you a member of?

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