STATEMENT OF THE POLL
Election to the office of (president or director) of the Ordre des chimistes du Québec.
Region (where applicable) _____________________________________________________________
Number of electors ___________________________________________________________________
________________________________________________________________
| | |
| Number of valid ballots |__________|
| | |
| Number of rejected ballots |__________|
| | |
| Number of outer envelopes rejected |__________|
| | |
| Number of inner envelopes rejected |__________|
| | |
| TOTAL |__________|
| | |
| Number of votes cast for |__________|
| | |
| Number of votes cast for |__________|
| | |
| Number of votes cast for |__________|
| | |
| Number of votes cast for | |
| ____________________________________________________|__________|
Signature of scrutineers: ______________________________________________________________
______________________________________________________________
______________________________________________________________
Given under my signature at _________________ this __________ day of _____________________ .
(signature of secretary)