PRIVATE AND CONFIDENTIAL - Conservative Party of Canada Application for National Leadership Contestants

Petition in support of the nomination of JIM KARAHALIOS

as a candidate for the Leader of the Conservative Party of Canada.

The undersigned certify by signing that they are members of the Conservative Party of Canada.
All of the undersigned must hold active membership at least 21 days prior to submission of the
application.

Name (print) Name (print)

Riding Name Riding Name

Address Address

Telephone Telephone

Signature Signature

Name (print) Name (print)

Riding Name Riding Name

Address Address

Telephone Telephone

Signature Signature

Please copy this page as many times as needed.

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