Ballot Paper

[1]

Number one box with the number 1 next to the candidate of your choice
[2]You may then show as many further preferences as you wish by writing numbers from 2 onwards in other boxes.

Election of one [3] to the [1] 

		[4]

		[4]

		[4]

Remember, number at least one box.

This form is Approved Form AF2005-199 under section 52 of the Health Professionals Regulation 2004

Notes:
1.	
1.	Insert name of board
2.	Omit this sentence where there are only two candidates
3.	Insert name of the profession
4.	Insert name of candidate