Municipal Association of Victoria
SCHEDULE 4
Nomination Form (Clause 1 of Schedule 2)
Nomination for election of Board Members held on ____________________________
I, the undersigned _____________________________________________________
Being the representative of the ____________________________________________
(insert name of council)
do hereby nominate _____________________________________________________
(insert name of councillor in full)
as a candidate for election to the following position:
[ ] President
[ } Board member for the ___________________ region
(insert name of region)
(Mark with an ‘X’ the election for which the candidate is nominated)
Signature _______________________________________________________
And I, the above-named _________________________________________________
(insert name in full)
consent to the nomination and declare that I am the appointed
representative of _______________________________________________________
(insert name of council)
Signature _______________________________________________________
A separate nomination form must be completed and delivered to the Returning Officer for each election for which a candidate is to be nominated.