National Board Nomination Form | PACCP

PACCP National Board Nomination Form

This form may be used for nomination of a PACCP member for election or appointment to the National Board of Directors.

1. Nomination Type

Self-Nomination
Branch Executive–Nominated
National Board–Nominated
Nomination by Another PACCP Member

2. Nominator Information

(If self-nominated, please complete this section with your own information.)

Full Name *

Email Address *

Role / Capacity of Nominator *

Branch or Board Affiliation *

3. Nominee Information

Full Name *

PACCP Member Number *

Membership Level *

Branch / Region *

Email *

Phone Number

4. Board Role / Portfolio Interest

5. Statement of Interest

6. Skills & Experience Summary

7. Faith & Ethics Declaration

I affirm that I support PACCP’s Statement of Beliefs and agree to uphold the Code of Ethics.

8. Conflict of Interest Disclosure

9. Consent & Declaration

I confirm that the information provided is accurate and that the nominee has consented to serve if elected or appointed.