Board of Directors Nominations Form - Canadian AIDS Society

Board of Directors Nominations Form
Submit advance nominations by March 27, 2009 or nominations or on-site nominations for
PLWHIV/AIDS Directors no later than Friday, June 19 at 8:00 am, and for Regional and At Large
Directors by Saturday, June 20, 2009 at 5:30 pm EDT.
Fax or mail your nomination to the Canadian AIDS Society | 190 O’Connor Street, Suite 800
Ottawa, ON | K2P 2R3 | Fax: 613.563.4998
Please print or type clearly
NAME
ORGANIZATION
MAILING ADDRESS
CITY PROVINCE POSTAL CODE
DAYTIME TELEPHONE
EVENING PHONE
( ) ( )
FAX
( )
E-MAIL
1. Position sought: ______________________________________________________________________________
2. Why are you seeking a position on the Board of Directors of the Canadian AIDS Society What
motivates you to want to be a Board Member of a national coalition of community-based AIDS
organizations Please limit your response to the space provided.

3. Please provide a brief resume of your accomplishments and experiences.
(a) Tell us about your experience serving on a Board of Directors, serving as a staff member
under a Board of Directors and your experience serving on committees.
(b) What AIDS related experience do you have and what skills will you bring to the CAS Board
(e.g. advocacy, communications, policy development)
If supported by a CAS member organization, please complete section A.
Section A
“I certify that the information on the nomination application is accurate and that the individual named in this application has my
support.”
Name of supporting CAS
member organization
Name of Board chair
Signature of Board chair
If you are NOT affiliated with a CAS member organization please get a health care professional
(doctor or nurse) and two persons living with HIV/AIDS in your region to certify the statement below
in section B.
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Section B
“I certify that the information on the nomination application is accurate and that the individual named in this application has my support.”
Signature of health
care professional
PLWHIV/AIDS signature
Email
PLWHIV/AIDS signature
Email
Date
Date
Phone
Date
Phone
Candidate Signature: ____________________________________________________
Date: ________________
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