Ballot Paper

[1]

Number [2] boxes from 1 to [2] in the order of your choice
[3]You may then show as many further preferences as you wish by writing numbers from [4] onwards in other boxes.

Election of [2] [5] to the [1] 

		[6]

		[6]

		[6]

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

This form is Approved Form AF2005-200 under section 52 of the Health Professionals Regulation 2004

Notes:
1.	
1.	Insert name of board
2.	Insert number of vacancies
3.	Omit this sentence where the number of candidates is one more than the number of vacancies
4.	Insert number that is 1 more than the number of vacancies
5.	Insert name of the profession
6.	Insert name of candidate