Nominator Form Name(Required) First Last CRNNL Registration Number(Required) If you do not know your CRNNL Registration Number, please use the Public Directory to find it.Contact InformationAddress(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Email(Required) NominationI, a current member of CRNNL, nominate(Required) (Name of Nominee)as a candidate for the position of(Required) Advanced Practice Councillor Practice Councillor Nominee's e-mail address(Required) The nominee will receive a confirmation that the nomination form has been submitted at the e-mail address included above.Consent By checking this box and typing my name below I confirm that the information provided is true and accurate.Member's Full Name(Required) Date(Required) EmailThis field is for validation purposes and should be left unchanged.