SP - 2019 Executive Nomination Form


I, ____________________ of ____________________ (Department) hereby express my willingness to serve on the Applied Science and Patent Examination (SP) Group National Executive.

Signature: ______________________________ Date:  ____________________

Membership Number: ____________________

Tel: (personal) __________________________ (work) __________

Email: (personal) ________________________ (work) __________

Mailing Address (work address for Regular members, home address for Retired members):




Please indicate with an “X” the position you are seeking:

___ Atlantic

___ Québec

___ Ontario

___ Prairies and Northwest Territories

___ British Columbia and Yukon

___ National Capital Region (NCR)

Please indicate your membership status:

___ Regular member

___ Retired member

Each nomination must be supported by five (5) members.  The following members in good standing with the Applied Science and Patent Examination Group sponsor me for nomination to the Group Executive (both signature and clearly printed name are required) [Bylaws 7.2].

Printed Name / Signature

1.  ________________________________________
Membership Number: ____________________

2.  ________________________________________
Membership Number: ____________________

3.  ________________________________________
Membership Number: ____________________

4.  ________________________________________
Membership Number: ____________________

5.  ________________________________________
Membership Number: ____________________

Candidates are asked to submit a brief résumé with their nomination.  The résumé describing their goals and experiences with the Institute and the SP Group.  The résumé shall not exceed 200 words for English submissions; and, 230 words for French submission, the word count will be based on Microsoft Word, versions 2010-2016.  Please note that there will not be a subsequent opportunity to submit or revise the résumé.  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 the candidates.  It is recommended, but not mandatory, that résumés be submitted by e-mail to dlanthier@pipsc.ca.  Candidates should contact Diane Lanthier at the PIPSC National Office (613-228-6310 or 800-267-0446 ext.: 4716) to confirm receipt of their nomination form prior to the deadline.  The Elections Committee is authorized to verify any statements of fact made by candidates in their résumés prior to publication [Bylaws 7.2].  Ballots, if required, will be emailed to members in March.

Completed forms are to be received by email no later than 4:00 pm (close of business, Ottawa time), February 18th, 2019.