ESC Board application form

Application form for Board Membership only

For use by new Board members or those seeking re-election
For your information: this application form will be distributed to all paid-up ESC members from your country.

Introduction

Application

Please read the descriptions of the post before applying! Details are included in the Statutes, Rules and Policies.

All new members standing for election or current Board members standing for re-election, must complete this application form. All meetings and correspondence are in English. Applicants must be able to commit the time and resources requested of them as a member of the Board.

Please be aware that - in case of election - you are supposed to attend the meeting of the Board in Bilbao (Spain) on Wednesday 1 May 2024 (13:00 - 17:30). More information and agenda will follow in due time.

Who can apply?

Any paid–up member of ESC in 2024 may apply, regardless of professional group.

Deadline

Applications MUST be received at the ESC Central office by 1 March 2024.
Late applications will not be accepted.
A. Name and contact details of the applicant
Title

Prof.Ass.Prof.Dr.Ms.Mr.
Full name of applicant

First NameLast Name
Job title

Medical doctorNurseMidwifeCounselorOther
Qualifications
Present appointment(s)
Address (work)

Institute & department

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile phone Number

Area CodePhone Number
E-mail*
B. Application details
In max 150 words explain why you wish to represent your country on the ESC Board:

0/150
In max 150 words explain what expertise you will bring to the ESC Board:

0/150
List any previous work for ESC as Board or committee/group member (maximum 50 words):

0/50
C. CV
Please paste here a short CV (max 500 words)

0/500
Note - Applicants and members will be informed of the results and then the results will be announced formally at the General Assembly in Bilbao, Spain (2 May 2024, 17:30 - 18:45).

I have read, understand and agree with the information provided on the ESC website: https://escrh.eu/about/#statutes*

	Read, understand & agree
Statutes: Article VI The Board of Directors
Rules: 4. The Board of Directors (appointment, mandate, election, duties)
Policies: 4.4. Election procedure for Board Members
I am aware that I should attend the Board meeting in Bilbao, Spain on 1 May 2024 (13:00 - 17:30) in case I am elected.
I am aware that the decisions made by the General Assembly in Bilbao may change the current content of the Statutes, Rules and Policies, related to Board membership.

Full Name

First NameLast Name
Date

DayMonthYear
Questions? ESC Central Office: info@escrh.eu / Tel. 0032 2 582 08 52
European Society of Contraception and Reproductive Health
ESC Central Office, Opalfeneweg 3, B-1740 Ternat, Belgium
Tel +32 2 582 08 52
info@escrh.eu - www.escrh.eu
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Application form for Board Membership only