Canadian Food Inspection Agency Scientific and Analytical Group NOMINATION FORM 2019
Three (3) Members-at-Large from outside the National Capital Region and for one (1) Atlantic Region, one (1) Ontario Region and one (1) National Capital Region representatives
I, ________________________________, hereby submit my nomination for the Canadian Food Inspection Agency Scientific and Analytical Group Executive for the following position:
- Atlantic Region Rep __________
- Ontario Region Rep __________
- National Capital Region representative __________
- Member at large _________
_______________________ ______________________ _____________________________
Date Signature Membership #
PLEASE INDICATE CLEARLY YOUR REGION
Atlantic: _____ BC/Yukon: _____ Ontario: _____
National Capital: _____ Prairie/NWT: _____ Québec: _____
Tel.: Work _________________________ Tel.: Home _________________________________
Email: Work ______________________ Email: Home ______________________________
Home address ________________________________________________________________________
The following members in good standing from the Scientific and Analytical Group endorse my nomination to a Group Executive position. Their signature and name in block letters are below.
ENDORSED BY: ________________________ __________________________ ___________________
Name Signature Membership #
ENDORSED BY: ________________________ __________________________ ___________________
Name Signature Membership #
ENDORSED BY: ________________________ __________________________ ___________________
Name Signature Membership #
ENDORSED BY: ________________________ __________________________ ___________________
Name Signature Membership #
ENDORSED BY: ________________________ __________________________ ___________________
Name Signature Membership #
A biographical sketch of not more than 200 words setting out your objectives and experience must be submitted electronically to mseguin@pipsc.ca by the deadline date (October 16th, 2019 at 5 pm ET) for inclusion in the kit if an election is required. Please note that it is the responsibility of candidates to review their bios before they are submitted. The bios will not be proofread and corrections will not be made except when requested by the Elections Committee. They will be inserted into the Elections newsletter as submitted by candidates.