The Royal Society of Chemistry

Burlington House

Piccadilly

London

W1J 0BA

Tel: 020 7440 3341

e-mail:

Nomination Form

Elected member of Science, Education and Industry Board

(Please use block capitals or type)

Note: All the information provided may be required for publication in a ballot paper, subject to editing by the Chief Executive.

We, the members of the Royal Society of Chemistry who have signed overleaf, hereby nominate for the office of elected member of Science, Education and Industry Board from the RSC Annual General Meeting in July 2017:

Full name and title of nominee
Honours, degrees, etc
Occupation/position held
Declaration to be signed by nominee:
I have read the Guidance for candidates for Elected Member of Boards and I hereby declare that I am willing to accept office and, if elected at the next Annual General Meeting, to make the necessary commitments, as elected member of the Science, Education and Industry Board.
Signature of nominee ……………………………………………………………….
Name:
Address:
Date: / Daytime Telephone:
E-mail:

Registered Charity No. 207890

Elected member of Science, Education and Industry Board - Candidate information:

1.  All the information provided may be required for publication in a ballot paper, subject to editing by the Chief Executive. As a guide, the maximum space available to each candidate, in addition to name, title and position, is approximately 400 words/40 lines. Information should be not more than one page, Ariel 11 font, margins 2.4 cm.

2.  It is recommended that the information required on this page is sent by e-mail to

Candidate's statement: (please provide a statement illustrating your reasons for standing as a candidate) up to 250 words
Education and career: in order of past to current date
Date / Description
Contributions to RSC: in order of past to current date
Date / Description
Public appointments held: in order of past to current date
Date / Description

Registered Charity No. 207890

Signatures of members supporting the nomination of

(candidate’s name, please print) ………………………………………………………….

Note: As an alternative to signing this form, members may e-mail a message of support to stating the name of the candidate whom they are supporting and the vacancy for which the candidate is being nominated and giving their own full name and RSC membership number.

Name in capital letters / Signature / RSC membership no.
1. 
2. 
3. 
4. 
5. 

Note: The following provisions are relevant to candidates and nominations:

Position / Period of service (years) / Eligible to be a candidate / Eligible to nominate / No. of signatories
Elected member of the Science, Education and Industry Board / 3 / All members of the RSC1 / All members of the RSC / 5

1 refer to General Principles for terms of office on Boards

A completed signed copy of this nomination form is required to reach the RSC addressed to Hilary Beckett, Governance Co-ordinator, Royal Society of Chemistry, Burlington House, Piccadilly, London W1J 0BA or by email at by 6 March 2017

Registered Charity No. 207890