Nomination Form

I,  regular member of the (Region) hereby

express my willingness to serve on the CFIA Veterinary Medicine (VM) Group Executive.

DATE

SIGNATURE

WORK PHONE NUMBER:        

WORK E-MAIL ADDRESS:

HOME PHONE NUMBER:    

HOME E-MAIL ADDRESS:

Please accept my nomination for the following position (check one only):

REGIONAL REPRESENTATIVE

NCR                                   

Prairie/Northwest Territories                                      

BC/Yukon

MEMBER-AT-LARGE                                  

Member-at-large

NOTE:    A candidate may run for only one executive office.  The nomination must be supported by at least three (3) Regular Members of the CFIA-VM Group.   The names must be clearly printed and signatures for all sponsors are required.

The following regular members in good standing of the CFIA Veterinary Medicine Group sponsor me for nomination to the CFIA-VM Group Executive. 

PLEASE PRINT  /  SIGNATURE

1.

2.

3.

Candidates are encouraged to include with their nomination form a 200 word write-up, submitted in Word format, on why members should vote for them. 

Nomination forms must be received by e-mail (with scanned nomination attached) to group_elections@pipsc.ca no later than noon (Ottawa time) November 15th, 2017.