Nomination Form

If you wish to seek nomination for the position of Board Member, Provincial Health Ethics Network, please complete and mail this form to the following address:

Provincial Health Ethics Network
Room #507 Guardian Building
8220 - 114 Street
Edmonton, Alberta T5N 3W6

Questions or comments? Please contact us toll-free at 1-800-472-4066 (Edmonton) or 1-800-472-6132 (Calgary).


  1. Full Name _________________________________________________

  2. Occupation _________________________________________________

  3. Professional Affiliation(s) _________________________________________________

  4. Please discuss below your interest in health ethics, highlighting areas of particular interest

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  5. What do you feel you could bring to the PHEN Board, if elected?

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  6. Other Comments

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  7. Signatures of two (2) nominating PHEN Members in good standing.

    Full Name (Please print) _________________________________________________

    Signature_________________________________________________


    Full Name (Please print) _________________________________________________

    Signature_________________________________________________