NCR-RO/RCO COSH nomination form

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Name

Membership number

Find your membership number.

Email (personal)

Phone number

I would like to put forth my name to be on the PIPSC Committee on Occupational Safety and Health (COSH) as:

Employee representative

Employee co-chair

I work at (indicate name of research centre, program, or branch):

I hereby consent to serve on this committee if approved.

Yes

Date

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