A-002 List of Executive / Mission Statement

List of Executive/Mission Statement

LIST OF EXECUTIVE / MISSION STATEMENT

5 MEMBERS REQUIRED

Name of Orgranization

Date

In accordance with section(s) 23(1) and (2) of the Lotteries regulations which state 23(1) “ A charitable or religious organization that has been granted a lottery licence, shall immediately notify the Minister in writing of any changes of any members of its executive” 23(2) “ Until such notice is given, a licence is deemed to be suspended”, we hereby submit our current list of Executive and sample of their signatures. In addition, a new form will be submitted when any change or deletion occurs.

Mission Statement

Name of Officer

Title of Orgranization

Email Address

Telephone Number(s)

Work & Resident

Personal Mailing Address

Personal Physical Address

Signature

Sign above

Name of Officer

Title of Orgranization

Email Address

Telephone Number(s)

Work and Resident

Personal Mailing Address

Personal Physical Address

Signature

Sign above

Name of Officer

Title of Orgranization

Email Address

Telephone Number(s)

Work and Resident

Personal Mailing Address

Personal Physical Address

Signature

Sign above

Name of Officer

Title of Orgranization

Email Address

Telephone Number(s)

Work and Resident

Personal Mailing Address

Personal Physical Address

Signature

Sign above

Name of Officer

Title of Orgranization

Email Address

Telephone Number(s)

Work and Resident

Personal Mailing Address

Personal Physical Address

Signature

Sign above

Consumer Affairs
Department of Community and Government Services
P.O. Box 440
Baker Lake NU X0C 0A0
Email: @email
Toll Free: 866-223-8139
Fax: 867-793-3321

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