Committee Nomination Form

Enter Your Name

First NameLast Name

Current Committee Members

Nominations

Nominations need not be in running order. Please select THREE unique nominees.

Should you have any questions or wish to discuss your nomination with us, please email us at scleroqld@gmail.com.

Newly Elected Nominee

Nominee Position

Nominee #1

Nominee Position

Nominee #2

Nominee Position

Nominee #3

Nominee Position

Scleroderma QLD Committee Nomination