Nomination Form

This form is to be completed by the owner or management member of a Manitoba Trucking Association member company in good standing.

The applicant below has been actively and directly engaged in the formulation, direction, or execution of policy in a managerial capacity as at the date of the application, and employed continually in the trucking industry for at least twenty-five years and is hereby nominated for membership in the MTA Pioneer's Club.

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* 1. Nominee Name:

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* 2. Name of Company, Partnership, or Sole Proprietorship:

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* 3. Business Address:

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* 4. Present Managerial Position:

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* 5. Date nominee first commenced employment in truck transportation:

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* 6. Name of first company:

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* 7. First employment capacity:

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* 8. Certification of Senior Operational Officer of company/partnership or by owner of an undertaking where applicant is employed.

I hereby certify that the applicant is actively and directly engaged in the formulation, direction, or execution of policy in a managerial capacity as at the date of the application and that the applicant has been continually employed in the trucking industry for at least twenty-five years.

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