Dialogue Volume 15, Issue 2 2019 - Page 58

Nomination Form Council Member Candidate STEP 3 – Candidate Consent Type or print only: I consent to allow my name to stand for election for Council Member. ( this information will not be shared with others) Name:­­­­­­­­­­­­­ District #: CPSO Number: Please email your application or submit it through the College website: http://www.cpso.on.ca/ councilelections Signature:­­­­­­­­­­­ Home Tel.: DEADLINES FOR NOMINATION FORMS Business Tel.: Street Address: Email: councilelections@cpso.on.ca Forms must be received by 4:00pm Tuesday, August 27, 2019. City/Province/Postal Code:­­­­­­­­­­­­­­­­­­­­­­­­­­ STEP 4 – Nominators To stand for election, you must be nominated by five members of the College who are: eligible to vote in the district in which you are being nominated; not in default of payment of fees owed to the College and who have a license that is not under suspension or revoked. We recommend that seven nominators be provided in the event that a nominator does not meet these criteria. We the undersigned members who meet the eligibility criteria identified above, nominate the above-named candidate for election: Print Name Signature CPSO Number 1. 2. 3. 4. 5. 6. 7. 58 DIALOGUE ISSUE 2, 2019