Nomination form

First Name:__________________________________

Last Name:___________________________________

Email address:_________________________________

Your mobile phone number:________________________

The name of your brigade:__________________________

Please indicate which of the following you are nominating for:

___ Zone Representative (State Committee)

___ Boards Position/s

Return the nomination form to [email protected]

Unit 3 14 Brodie-Hall Drive Bentley Western Australia | www.bushfire.org.au | Freecall: 1800 BF VOLS