2026 Board Nomination Form

CanSAGE Board of Directors

Nominations will close on June 15, 2026 at 5:00 p.m. ET
Propose a candidate*

Nominee: Proposing myself as a candidateNominator: Supporting the nomination of another member
Who is this nomination for?*

First NameLast Name
Board position*
Contact Information
If you are a nominator, please use your own contact information in case we need to reach you.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Nominee Information
Are you a practicing gynecologist?*

YesNo
Do you have CanSAGE Board experience?*

YesNo
Are you a first or second year fellow?*

YesNo
File Upload (headshot photo)*

Cancelof
Biographical sketch (maximum 100 words)*
Statement (why you wish to be considered; maximum 200 words)*
Confirmation
I hereby confirm and give my consent as a Nominee for the CanSAGE Board of Directors 2026 Elections*

Yes
I hereby confirm my support for the above-mentioned Nominee for the CanSAGE Board of Directors 2026 Elections*

Yes
Questions? Please contact: CanSAGE Administration – admin@cansage.org
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CanSAGE Board of Directors