* Nominator 

Name

* E-mail address:

* Telephone (with area code):

* Nominee 

Name

* Address

* Telephone (with area code):

* E-mail address:

* Current position:

* Employer:

* Statement of nomination (maximum 200 words) 
The statement should indicate the nominee’s rationale for accepting the nomination and outline his or her ability to bring to the board a broad perspective from outside the nursing profession that informs and strengthens dialogue and decisions at the board table.

* The nominee has consented to the nomination

* Please attach a brief curriculum vitae (CV) of the nominee

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FOR FURTHER INFORMATION
Manager of Governance and Events
Canadian Nurses Association
50 Driveway, Ottawa, ON  K2P 1E2
1-800-361-8404, ext. 214, or
e-mail: dross@cna-aiic.ca

Privacy policy: Personal information collected on this form will be used only for processing nominations and related follow-up.

 

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