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I, …………...........................................…………………………
(member of Executive Board),
nominate for membership of The John Fawcett Foundation:
Name of nominee: …………………..........................................................………………………………...
Address of nominee:…………………………...…………..…......………………………………………………..
......................................................................................................................................................
Email address: ……………………………………............................................................................……
Signed: Nominator
(member of Executive Board): ….........................……………
Date: ____/____/____
I accept membership of The John Fawcett Foundation.
(AUD $50 per annum)
Signed: Nominee:
…………….......................................................……………..
Date: ____/____/____
Please send a cheque made payable to The John Fawcett Foundation with your nomination form to:
Dr John Lake
Secretary, The John Fawcett Foundation
102 Palmerston Street
Mosman Park, WA 6012
Tel/fax: +61 8 9286 1232
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