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1. Name of Nominee (Required.)

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2. I am a current financial member of Palliative Care NSW (if unsure please call 02 8076 5600 to confirm)

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3. I hereby nominate for the position of:

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4. Do you work in regional, rural or remote NSW?

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5. What is your current position title?

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6. Current organisation name

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7. Please provide a short biography of no more than 200 words (this will be shared with members in the voting pack)

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8. In no more than 200 words, outline why you would like to be considered for this position and how your skills and experience would contribute strategically to the organisation (this will be shared with members in the voting pack) (Required.)

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10. Phone

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11. I understand that it is my responsibility to obtain the endorsement of 2 current financial members of Palliative Care NSW
This link will be shared with you when you complete this nomination

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12. I consent to my nomination being shared as part of the election process

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