Committee Members 2017-2019

NOMINATION FORM

This is NOT a voting or ballot paper.

Note (1): If you are nominating a new person to any of the following committees, details of their work related to the type of committee for which you are nominating them must be attached (previous experience, qualifications, position at national level, etc.).

Note (2): An individual may not serve on more than one (1) of the following committees (exception may be made by the Board of Directors), and an Association may not be represented on more than four (4) of the following committees.

Note (3): If you wish your Nominee to be considered as Chair of a committee, please indicate in the appropriate box.

Note (4): Clause 1.11.11 of the ITTF’s Constitution indicates that where sufficient nominations are received, 25% of the committee will be women.

Male or Committee Chair Committee Name of nominee Female (yes/no) Equipment (8 members)

Media (8 members)

Para TT (6 members)

Rules (6 members) __ Chair Sports Science and __ Anti-Doping Medical (6 members)

Umpires and Referees (8 members)

Veterans (6 members)

Nominated by the Association of:

Signature:

Name and position in the Association:

Deadline for nominations for commissioners and working groups is 31 March 2017 (received by the ITTF as email attachment) International Table Tennis Federation

Send by email ONLY: E-mail: [email protected] AND [email protected]

 All names will be made public by 15 April 2017  Committee members will serve for a 2-year-term  Nominees must be nominated by their National Association  Nominations will not be accepted after the deadline of 31 March 2017

NOMINATIONS DETAILS Please attach a passport type photo (jpg format, 300 dpi) Name and Surname Nationality (as shown in passport)

Address:

Telephone:

Email address:

Date of birth:

Language/s spoken:

Professional work:

Educational qualification:

Table Tennis achievements:

Statement of what you hope to achieve on the Committee