Nomination Form for Doctors of BC's 2024 Elections

Candidate's Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I confirm I am a Family Physician seeking the position of Board Director at Large (Family Physician)*

Yes

Nominators' Information
I, Candidate First Name* Candidate Last Name* Doctors of BC ID, confirm that I have secured the nomination of the following TWO nominators:
Nominator #1 First Name* Nominator #1 Last Name*, Nominator #1 Doctors of BC ID*, a Doctors of BC member in good standing.
Nominator #2 First Name* Nominator #2 Last Name*, Nominator #2 Doctors of BC ID*, a Doctors of BC member in good standing.

As a candidate for Board Director at Large, I confirm I have read the Board Role Descriptions and am aware of the core duties that members of the Board are collectively and individually responsible for, and the core competencies and attributes to be demonstrated.*

Yes
I confirm that I have read the Doctors of BC Election Policy and agree to abide by it.*

Yes
I acknowledge the due date to submit campaign materials as referenced in the Election Policy is Tuesday, February 18, 2025 by 12:00PM noon PST.*

Yes
While the online nomination form does not require signatures from the candidate or nominators, I acknowledge that they may be contacted to verify and confirm their role in the nomination.*

Yes
Should be Empty:

Nomination Form for Doctors of BC's 2025 Board of Directors By-Election