Board of Directors Application Form

    General Contact Information:


    Phone Number



    Agricultural classification of your operation or workplace?

    Where is your operation or workplace located? (City & Closest Community)

    Commodity Association Reference:

    Please ask your commodity association for a reference to support your application for the board.

    Association Name:

    Contact Information:
    Permission for AgSafe to contact your reference YesNo

    Are you eligible?

    The Society Act says that you can’t be a Director if you fit any one of these categories. Please check any that apply to you.


    The AgSafe Board includes four categories of Directors. Do you fall into one or more of these categories? Please check any that apply to you.


    Do you have previous board experience? YesNo
    If so, with which organization?


    What skills or abilities can you bring to help the board to do its work?


    What would you like to learn as a Director?

    Do you have any real or potential conflicts of interest? For example, do you make money from an organization that lobbies WorkSafeBC? YesNo

    Participating on the AgSafe Board requires about 2-4 hours a month, including preparation, Board and Committee meetings. Can you meet this requirement?YesNo

    Terms of Submission

    By sending this to AgSafe's Executive Director, you affirm that the information you have provided is true.

    By sending this to AgSafe's Executive Director, you affirm that AgSafe has permission to contact you directly via the information provided.


    How will the information you provide be used by the Nomination Committee and AgSafe?
    AgSafe is subject to legislation that limits how we can use any information we collect, and we will only share information that is relevant to members in the process of electing Directors.