Nomination Form LCDC 2024

1

Terms And Conditions

I am a member of a group registered with Waterford PPN (at least 6 months)
Waterford PPN is non political, I agree as a representative to abide by this ethos in its entirety
I have read the role and responsibilites of the position HERE
I am aware that Elections may take place post Nomination process
I have the authorisation of my group/organisation to submit this Nomination and I understand that they will be contacted to confirm.

2

I agree to the Terms and Conditions as stated on Previous Page* This field is required.Nomination is only valid if you agree to the terms and conditions

YESNO

3

Chose One* This field is required.

Community & Voluntary Rep

Social Inclusion Rep

Environment Rep

4

Name* This field is required.

First Name

Last Name

5

Email* This field is required.

example@example.com

6

Phone Number* This field is required.

Home

Mobile

7

* This field is required.Name of the PPN Organisation you are a member of

8

* This field is required.Please tell us briefly why you are applying for the position (MAX 150 words)

9

Declaration * This field is required.I understand and agree that the data given on this form will be held and used by Waterford PPN in relation to the 2019 PPN Elections.

YESNO