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* 1. Contact details

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* 2. I am nominating as a:

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* 3. I would like to nominate for the:

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* 4. If you are nominating for the Board, please indicate in which areas you have skills and experience:

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* 5. If you are nominating for the Operations Committee, please indicate your acknowledgement and understanding of the following by ticking both boxes:

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* 6. Acknowledgement

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