• Nominator (Full Name):
• Nominee (Full Name):
• Organisation (or Affiliation):
• Current Position:
• Physical address:
• E-mail address:
• Phone number:
• Fax number:
• Country of Residence:

Secondment: :
1. (Name, e-mail address, Organisation)
2. (Name, e-mail address, Organisation)

(Candidate must provide two valid references that the NomCom could contact for further information and background check)

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Brief statement explaining the candidate's background and motivation
(Not more than 400 words):

A copy of candidate’s Resume and a picture will be requested and used for publication