Nomination Form

Nomination Form

Faculty Elections 2023
Your Full Name*

First NameLast Name
Your membership number*
Your address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your email address*
example@example.com
Full name of the candidate you wish to nominate*

First NameLast name
Please select the Faculty that you wish to nominate this candidate for*
Please confirm you are eligible to nominate this candidate

I can confirm I am a Full or Life Member of the Society, and therefore eligible to nominate
I hereby act as to propose First Name* Last Name* as a candidate for election.
Signature*

Clear
Date today*

MonthDayYear
Date
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