Board Member Application Form

In order to ensure a fair and effective process for the selection of board members for the provincial board, we are asking all nominees to complete and submit this form.

Please fill out all fields.










Please check off appropriate category.
SurvivorFamily MemberProfessional
Indicate the reasons for your interest in serving on the Provincial Board of BIANS. Also, please provide details of any past involvement with BIANS, either provincial and/or Halifax (if any).

What skills and assets will you offer to the Board?

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