IEA Nomination Form
1. Position for nomination (please select one)
*
President-Elect
Secretary
Treasurer
Councilor
2. Region (required for Regional Councilor nominations only)
*
Africa
Europe
Latin America and the Caribbean
Middle East and North Africa
North America
South-East Asia
Western Pacific
3. Nominee Details
Name
*
First Name
Last Name
Email
*
example@example.com
Institution/Organization
*
Country
*
Current position/title
*
4. Is the nominee a current IEA member?
*
Yes
No
5. Please upload a short CV of the nominee in PDF
*
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6. Candidate Statement (max 300 words)
*
0/300
7. Nominator information
Nominator 1
Name
*
First Name
Last Name
Email
*
example@example.com
Is the nominator a member of IEA?
*
Yes
No
Nominator 2
Name
*
First Name
Last Name
Email
*
example@example.com
Is the nominator a member of IEA?
*
Yes
No
8. Declaration
Name of person who completed the form
*
*
Signature
*
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