NOMINATION FORM Western Australian Regional Committee Casual Vacancy Positions We, the undersigned, being full financial Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), resident in Western Australia, nominate the below Fellow for election as a Fellow Representative to the Western Australian Regional Committee until September 2019. Nominee Details First Name (s) Title Surname Email Proposer Details (Proposer to complete all sections) First Name(s) Title Surname Signature Date Seconder Details (Seconder to complete all sections) First Name(s) Title Surname Signature Date Nominee Declaration (Nominee to read and complete the following declaration)
NOMINATION FORM Western Australian Regional Committee Casual Vacancy Positions We, the undersigned, being full financial Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), resident in Western Australia, nominate the below Fellow for election as a Fellow Representative to the Western Australian Regional Committee until September 2019. Nominee Details Title First Name (s) Surname Email Proposer Details (Proposer to complete all sections) Title First Name(s) Surname Signature Date Seconder Details (Seconder to complete all sections) Title First Name(s) Surname Signature Date Nominee Declaration (Nominee to read and complete the following declaration)
Nomination-Form_WA.docx