Professional Section Vice Chair Nominations

Nomination Application Form, Vice Chair Professional Section

Thank you for your interest in applying for the Vice Chair position on the Professional Section. All applicants who meet the requirements will be eligible for an election, as voted on by Professional Section members. 

Requirements:
- Be an active Professional Section member
- Complete the attached nomination application and Candidate Profile form
-Give permission to the PS and DC to use candidate profile information for promotions and communications within PS and DC communication channels

If you have any questions, please e-mail Grace.Leeder@diabetes.ca.

Unless otherwise noted, Diabetes Canada will use the data collected for analytical purposes to determine what services we can provide to better understand and manage diabetes. Identifiable information will only be collected with your consent and unless otherwise notified will not be shared other than with Diabetes Canada or its affiliates who may complete data analysis on Diabetes Canada’s behalf.

By providing your contact information you are permitting Diabetes Canada to contact you.
1.Applicant's Name(Required.)
2.Applicant's Address(Required.)
3.Applicant's City & Province(Required.)
4.Applicant's Postal Code(Required.)
5.Applicant's Phone Number(Required.)
6.Applicant's Email Address(Required.)
7.Applicant's Length of Membership
8.Professional Registration/Licensing Body & Number(Required.)
9.Please list the applicant's post secondary education
10.Professional Work Experience & Positions Held
11.Diabetes Canada volunteer experience
12.Other volunteer experience
13.Candidate's Comments
14.I, the undersigned, am an active member, in good standing, of the Professional Section of Diabetes. 

I, the undersigned, accept the nomination for the position of vice-chair, professional section and allow my name to stand as a candidate.

I agree that if the need to withdraw my nomination should arise, I will provide notice two weeks prior to the start of the election.   
  
In addition, I agree to permit the Professional Section and Diabetes Canada to use candidate profile information for promotions and communications within PS and DC communications channels.

(Please write your name below).