Ballot Paper

[1]

Number [2] boxes from 1 to [2] in the order of your choice
You may then show as many further preferences as you wish by writing numbers from [3] onwards in other boxes.

Election of [2] [4] to the [1] 

		[5]

		[5]

		[5]

Remember, number at least [2] boxes from 1 to [2] in the order of you choice

This form is Approved Form AF2005-191 under section 52 of the Health Professionals Regulation 2004

Notes:
1.	
1.	Insert name of board
2.	Insert number of vacancies
3.	Insert number that is 1 more than the number of vacancies
4.	Insert name of the profession
5.	Insert name of candidate