Ethnic Communities Council of NSW Cope Street Waterloo NSW

							                       Ethnic Communities’ Council of NSW
                       221 Cope Street, Waterloo NSW 2017
                       Phone 9319 0288       Fax 9319 4229
                       Email admin@eccnsw.org.au
                       Website www.eccnsw.org.au


                       NOMINATION FOR COOPTION TO EXECUTIVE COMMITTEE
                                        Please use block letters
              I the undersigned Proposer nominate for cooption to the Executive Committee
                        NOMINATION (To be completed by the person Nominating)
FIRST OR GIVEN NAME Mr/Mrs/Ms/Dr
SURNAME OR FAMILY NAME
Who is a financial delegate of:
(Name of Organisation if applicable)
Or is a financial Associate Member of the Council                           Tick if applicable

    ACCEPTANCE OF NOMINATION (To be completed and signed by the person being nominated)
FIRST OR GIVEN NAME Mr/Mrs/Ms/Dr
SURNAME OR FAMILY NAME
ADDRESS 1
ADDRESS 2                                                                          POSTCODE
TELEPHONE (W)                                                   TELEPHONE (H)
MOBILE PHONE                                                              FAX
EMAIL ADDRESS

I hereby accept this nomination (Signature)


PROPOSER: I believe that the person nominated will be a useful Member of the Executive Committee
because: (Give details of the Nominee’s ethnic community involvement)




FIRST OR GIVEN NAME Mr/Mrs/Ms/Dr
SURNAME OR FAMILY NAME
ADDRESS 1
ADDRESS 2                                                                          POSTCODE
TELEPHONE (W)                                                   TELEPHONE (H)
MOBILE PHONE                                                              FAX
EMAIL ADDRESS
I am a financial delegate of:
(Name of Organisation if applicable)
Or I am a financial Associate Member of the Council                             Tick if applicable

Signature

Office Use Only
Date Cooption Received                                          Date Cooption Approved
Received by:

Authorised by: Secretary’s Signature




ECC of NSW – Nomination for Cooption to the Executive Committee – 2005                         1 of 1