Health Professionals Regulations 2004	
	
Number three boxes from 1 to 3 in the order of your choice	
You may then show as many further preferences as you wish by writing numbers from 4 onwards in other boxes.	
Election of three Members of the ACT Medical Board	
		
	Stephen Robert Bradshaw	
		
	Imogen Ann Mitchell	
		
	Hugh Victor Veness	
		
	Robert Charles Griffin	
		
	Martin James Duncan	
		
	Alan Normington Cowan	

Remember, number at least 3 boxes	
from 1 to 3 in the order of your choice 	
This form is Approved Form AF2004-133 under Regulation 52 of the 	
Health Professionals Regulations 2004	
The Legislation Act 2001, section 81 (4) applies to this form.