CFIA S&A Group Nomination Form 2017

REGIONAL POSITION

I, (PRINT NAME), hereby submit my nomination for the position of regional representative on the CFIA S&A Group Executive.

Date

Signature

PLEASE INDICATE CLEARLY YOUR REGION

Atlantic:

BC/Yukon:

National Capital Region (NCR):

Ontario:

Prairie/NWT:

Québec/Nunavut:

TEL.: Work

TEL.: Home

EMAIL: Work

EMAIL: Home

HOME ADDRESS

The following members in good standing from the Scientific and Analytical (S&A) Group endorse my nomination to a Group Executive position. Their signature and name in block letters are required.

ENDORSED BY:

Name

Signature

ENDORSED BY:

Name

Signature

A biographical sketch of not more than 200 words setting out your objectives and experience must be submitted electronically to group_elections@pipsc.ca by the deadline date (August 28, 2017 at 12:00 pm) for inclusion in the kit if an election is required.

Please note that it is the responsibility of candidates to review their résumés before they are submitted. The résumés will not be proofread and corrections will not be made. They will be inserted into the Elections newsletter as submitted by candidates.

Thank you.