TasCOSS Life Membership Nomination Form

1. TasCOSS Life Membership NomineePlease provide contact details of the individual you wish to nominate for TasCOSS Life Membership.1.1 Full Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title Given Name(s) Surname 1.2 Position/Job Title (if applicable)1.3 Organisation (if applicable)1.4 Email Address* Enter Email Confirm Email 1.5 Phone Number*2. TasCOSS Life Membership Nominating MemberPlease identify the TasCOSS Member responsible for the TasCOSS Life Membership nomination. NB: