1.Full Name (of person providing endorsement)

2.Email (of person providing endorsement)

3.Contact Phone No.

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 Secretary, Treasurer or General Member

Yes

No

5.Full Name of candidate

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

Send me a copy of my responses via email