DECLARATION OF SUPPORT | Liberal Party of Canada

Complete this form to indicate your support for Mark Carney for the position of Leadership Contestant of the Liberal Party of Canada.

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First Name*

Last Name*

Address*

City*

Province/Territory*

Postal Code*

Email*

Phone Number *

Date of Birth

Year*

month*

Day* Select year/month first

Riding

Affirmations (Required)

I declare that I hereby nominate the above-named individual for Leader of the Liberal Party of Canada and confirm that I am a duly qualified Registered Liberal residing in the province and riding noted above.

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