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
Date
Signature*
Should be Empty: