CCQM WGs' Contact Persons' nomination form

Please note the number of contact persons by Institute should not exceed two.

For any question, please contact johanne.flament@bipm.org

CCQM Working Group
Please select the concerned CCQM Working Group in the list below:*
Institute or Organization*
Institute or Organization
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Contact person 1 :
Name*

TitleFirst NameLast Name
E-mail*
E-Mail
Tel*
Tel
Contact person 2 :
Name

TitleFirst NameLast Name
E-mail
E-Mail
Tel
Tel
Person authorized to designate the contact persons :
Name*

TitleFirst NameLast Name
Position*
E-mail*
E-Mail
Date*

MonthDayYear
Date
Signature*
Should be Empty: