AGM Nomination Form
This form is to nominate a person to be elected on the Board of Directors of the Halton-Peel Community Aphasia Programs.

AGM Wednesday, September 29, 2021
This executed form must be received by the Secretary by September 9, 2021 at 5:00 pm
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Email *
Your first and last name *
Who would you like to nominate? Enter their first and last name. *
I would like to nominate this individual (as named above) for the following position with Halton-Peel Community Aphasia Programs (“H-PCAP”) for election at the 2021 Annual Membership Meeting to be held virtually at 7:00 p.m. on Wednesday, September 29, 2021: *
Required
Your address *
Your phone number *
By electronically signing this nomination form, the Member accepts the nomination to run for the above-noted position with H-PCAP.  This form is valid if executed in counterparts, that is, if the nominator and member sign separate copies so long as both are remitted to the Secretary by the deadline. *
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