2022/23 RGA Nomination Form

RGA Branch Representative Roles

You are required to complete and submit this form prior to commencement of the Branch Annual General Meeting to be eligible to stand for election in one of the Branch Representative roles.

Question Title

* 1. Title

Mr.

Mrs.

Ms.

Miss.

Other (please specify)

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* 2. Full Name

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* 3. Email address

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* 4. Mobile phone number

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* 5. RGA Branch

Berriquin

Coleambally

Deniliquin

Hay

Mirrool

Victoria

Wakool

Yanco

Question Title

* 6. Branch Position Nomination (please tick box/s for position/s selected below)

Branch President

Branch Vice President

Branch Secretary

Central Executive Delegate

Central Executive Alternate

Seed Committee

Question Title

* 7. Wakool Branch Position Nomination Only

Moulamein Shed Committee (Wakool Branch Nominations Only)

Burraboi Shed Committee (Wakool Branch Nominations Only)

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* 8. Nominated By (note that you may self-nominate)

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* 9. Nominee acceptance (required if nominated by another party only)

I accept the nomination.

I decline the nomination.

2022/23 RGA Nomination Form

RGA Branch Representative Roles

Question Title

* 1. Title

Question Title

* 2. Full Name

Question Title

* 3. Email address

Question Title

* 4. Mobile phone number

Question Title

* 5. RGA Branch

Question Title

* 6. Branch Position Nomination (please tick box/s for position/s selected below)

Question Title

* 7. Wakool Branch Position Nomination Only

Question Title

* 8. Nominated By (note that you may self-nominate)

Question Title

* 9. Nominee acceptance (required if nominated by another party only)

Question Title

* 10. Nominees Signature (Full Name, as unable to sign) and Date