NOMINATION PAPER FOR THE ELECTION OF A DIRECTOR IN THE _____________ REGION
We, the undersigned, members in good standing of the Ordre des chimistes du Québec, having our professional domicile in the region of ______________________________, nominate ______________________________ (name) of ______________________________ (address) as candidate for the forthcoming election in that region.
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| Member’s name | Permit number | Date | Signature of member |
|___________________|___________________|______________|__________________________|
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|___________________|___________________|______________|__________________________|
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|___________________|___________________|______________|__________________________|
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|___________________|___________________|______________|__________________________|
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|___________________|___________________|______________|__________________________|
I, ______________________________, having my professional domicile in the region of ______________________________ and nominated in the above nomination paper, agree to be a candidate for the office of director for that region.
In witness whereof, I have signed at ______________________________ , this __________ day of ______________________________ .
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(signature)