March 20, 2006 – This is the “Nominations Form” for the Paralympic Representative position on the Athlete & Coach Development Committee. Nominees for this position should have Paralympic cycling experience in any of the following capacities: athlete, coach, official, volunteer committee member or other similar capacity.

Nomination forms must indicate the name of the nominee and nominator. Verification that the nominee and nominator are aware of the nomination must be submitted. NOTE: All nominees must be members in good standing of the CCA. Nominees must meet minimum experience qualifications if any are indicated for the position. A brief written resume of the qualifications and experience of the nominee must accompany nomination.

NOMINEE: _______________________________________________________________________________

NOMINATED FOR THE POSITION(S) OF:_____________________________________________________

_________________________________________________________________________________________

NOMINATOR: ____________________________________________________________________________

Nominee’s phone number: ________________________ Nominee’s E-mail: ___________________________

Nominator’s phone number: ______________________ Nominator’s E-mail:__________________________

If you are not using this page to submit a nomination, all information in this box MUST be provided.

Please attach resume and return by March 24th to:

Canadian Cycling Association
203-2197 Riverside Drive, Ottawa, Ontario, K1H 7X3
Fax: 613 248-9311
Email: general@canadian-cycling.com

Nominations will be accepted until Friday, March 24th, 2006 — 4:00p.m PST