LPNABC Indigenous Councillor – Application Form

* all fields are required.

Full Name:
CLPNBC Registration Number:
In about 200 words, please provide a brief biography of yourself:
Nominee Form
Nominee Photo
Please attach all necessary files before hitting the Submit button
(valid files to upload include: PDF, DOC, DOCX, GIF, JPG, JPEG, PNG, RTF, TXT, XLS, XLSX)