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Member Review Council Application form - English
1.
Applicant contact information
First and Last Name
Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Country
Email Address
Phone Number
2.
Wawanesa policy number:
3.
How long have you been a Wawanesa policyholder for?
4.
Are you a Wawanesa policyholder in good standing (i.e., no arrears)?
Yes
No
5.
Who is your insurance broker for your Wawanesa policy?
6.
Please enter your insurance broker's contact information:
7.
What is your occupation?
8.
Why are you interested in volunteering on the council?
9.
What skills and/or experience would you bring to the council?
10.
Have you served on a board or panel before? If yes, please describe.
11.
What does fairness mean to you?
12.
Are you interested in being a council chair or co-chair?
Yes
No
13.
Please provide three references that can attest to your character and/or previous experience.
Reference 1
Reference 2
Reference 3
14.
Do you use assistive technologies on a daily or near-daily basis?
Yes
No
I'm not sure
If you answered 'Yes' please specify what assistive technologies you use:
15.
Signature - please type your name
Thank you for submitting your Member Review Council application form. Successful applicants will be contacted.
