Nomination form for CCTF-WGTAI contact person

For any question, please send an email to meetings@bipm.org
Institute
Name of your Institute or Organization
Institute or Organization
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Contact person for the CCTF-WGTAI
Name

PrefixFirst NameLast Name
E-mail
E-Mail
Phone number
Person authorized to designate the contact person
Name

PrefixFirst NameLast Name
Position
E-mail
E-Mail
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Signature
Should be Empty: