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Nomination Form 2017

Nomination Form 2017

Election of two Board Director positions SNPHN Ltd,
trading as Sydney North Primary Health Network

Please complete the Nomination form according to the SNPHN Nomination Procedure.

Completed forms are must be received no later than 5pm on 9 October 2017.

Name of nominating Member:

Name of Individual Member being nominated:

Profession of the Individual Member being nominated:

Number of Elected Director positions available:

Two

Nominee agrees to their nomination:

Nominee agrees

Experience in the relevant area and meets one or more of the requirements set out in the Skills Matrix.

Meets requirements set out in Skills Matrix:

Essential Criteria
Meets Essential Criteria (required)

Skills Matrix Criteria
Strategic DirectionLeadershipClinical Knowledge/experienceCorporate GovernanceCorporate ManagementCommunity and Stakeholder Engagement

Supporting Statement (no more than 250 words):

Find a local health service anywhere national-health-btn