BCRA Nomination Form

Name of Nominee*

Balsam Chutes Address*

Phone*

Ex. +17051234567

Email*

Profile & Experience/Skills*

I will attend up to 8 Board Meetings per year.

Signature*

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Date picker*

Name of Ordinary Member in Good Standing Supporting the Nominee*

Balsam Chutes Address*

Email*

Phone*

Signature*

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Date*

email: admin@balsamchutes.com

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