DO YOU HAVE A STAKE IN AGRICULTURE, A COMMITMENT TO CO-OPERATIVES AND A PASSION FOR MAKING A DIFFERENCE? UFA has a unique governance structure which connects our member/owners to our co-operative roots. Geographical areas referred to as districts are governed by a “delegate” who is elected by our member/owners within the districts. If only one nomination is received per district, the candidate may be acclaimed. Delegates use their Ag experience, knowledge of the industry and community relationships to provide insight and guidance, ensuring the voice of the member/owner is heard. Delegates provide leadership by being an advocate for UFA and supporting and representing UFA at community events within the district they represent. In return, delegates are provided with opportunities for professional development that include: Networking Governance development Communication Leadership Those interested in being nominated for the position of a UFA delegate are asked to self-assess their qualifications, skills and experience. In the space provided below, please provide a summary of your skills and experience in each category. This summary and your Personal Statement of Interest will be used for the purpose of developing a communication to members regarding the candidates running for election and their respective qualifications. Included with your nomination package you are required to provide: BIOGRAPHY REQUIREMENT Color Photo – incumbent delegates excluded Criminal Record Check – require categories 1 of the Consent for Disclosure of Criminal Record Information. Incumbent delegates will be advised if they are required to submit a criminal record check. NOMINATION FORM All requirements are to be submitted to Mike Lenz via email at Mike.Lenz@UFA.com or fax to 403-570-4021. Denotes required field First Name Please enter your first name Last Name Please enter your last name Address Please enter your address City/ Town Please enter the name of your city or town Postal code Please enter your postal code Province Please enter your province Email Address Please enter a valid email address Contact Number Please enter a valid phone number (###)###-#### UFA Membership Number Please enter your UFA membership number A. Eligibility Requirements Please make a selection to ther following questions regarding minimum eligibility requirements. Are you 18 years of age or older? Yes No Please make a selection Are you a resident in the district in which you are seeking nomination? Yes No Please make a selection Are you a member of UFA and eligible to vote? ($2,500 in purchases in the previous calendar year of $2,000 in equity) Yes No Please make a selection Are you an employee, an agent of or hold any office of profit with UFA? Yes No Please make a selection Do you hold any material interest in any agent of UFA or in any business in competition with UFA? Yes No Please make a selection Are you a member of the Canadian House of Commons or any Provincial Legislature? Yes No Please make a selection Have you been convicted of any offence under the Criminal Code of Canada for which no pardon has been issued? Yes No Please make a selection Do you have any relatives employed by UFA? Yes No Please make a selection If yes: Full Name Please enter your relative's full name Relationship Please enter your relationship to your relative Position Title Please enter your relative's position title How did you hear about the delegate nomination process in your district? Postcard Website Governance Advisor Social Media Statement Stuffer Other B. Biography Information Please introduce yourself, including occupation, experience, co-operative experience and community involvement. Please enter some biography information C. Personal Statement Of Interest Why would you like to be elected or re-elected as a delegate? Describe your personal attributes and interests that would make you an effective representative of members in an agricultural co-operative. Please enter a personal statement of interest D. References Please provide two professional references. Full Name 1 Please enter a full name Phone Number 1 Please enter a valid phone number (###)###-#### Full Name 2 Please enter a full name Phone Number 2 Please enter a valid phone number (###)###-#### Upon submission, you will be contacted by our Member Relations Department and will be asked to provide the following supporting documents for your nomination: Colour Personal Photo Criminal Record Check – require category 1 of the Consent for Disclosure of Criminal Record Information. By submitting this application form, I acknowledge that: All statements made in this application are true and accurate. Any misstatements of material facts herein may cause forfeiture of my position as a delegate with UFA. Please acknowledge our terms Errors found above Thank you for your submission. You will be contacted by our Member Relations Department and will be asked to provide the following supporting documents for your nomination: Colour Personal Photo Criminal Record Check – require category 1 of the Consent for Disclosure of Criminal Record Information.