2023
WORLD ATHLETICSCOMMISSIONSMEMBERSNOMINATION
FORM12

World Athletics Commissions Members Nomination FormThe Nomination Form must be received by the Nominations Panel by no later than 11 June 2023
(23:59 CET). This deadline will be strictly enforced. Nomination Forms must be sent by email tonominations.panel@worldathletics.org.
In addition to this form, Applicants must submit by latest 11 June 2023:• a letter detailing the Applicant’s suitability for one (or maximum two) Commission member positions,which clearly outlines their skills and experience, how they will make a contribution to the relative
Commission(s) and reasons for applying; and• a CV with two referees.
Please type in details in the highlighted fields
1.

INFORMATION ABOUT THE APPLICANT

1.1. POSITION(S) SOUGHT
Please tick one (1) or two (2) Commission(s) position(s)World Athletics COMPETITION Commission
World Athletics DEVELOPMENT Commission
World Athletics GOVERNANCE Commission

MEMBERMEMBERMEMBER

1.2. PERSONAL INFORMATION
Title
Family Name
Given Name
GenderDate Of Birth (dd/mm/yyyy)
Nationality
Preferred Language

1.3. APPLICANT CONTACT INFORMATIONHouse/Apartment No
Road/StreetTown/CityCounty/StateCountryMobileEmailPost/zip code

3

CHAIRPERSONCHAIRPERSONCHAIRPERSON2.

ENDORSEMENT BY MEMBER FEDERATION OR AREA ASSOCIATIONThe[NAME OF MEMBER FEDERATION/AREA ASSOCIATION] endorses
the application by[NAME OF APPLICANT] for a position as a WorldAthletics Commission Member.

2.1. MEMBER FEDERATION/AREA ASSOCIATION INFORMATION
Please state the Member Federation or Area Association which is endorsing the Applicant.
Name of Member Federation/Area Association:
Name and contact details of person signing your Application Form on behalf of the Member
Federation/Area Association:
Position of person signing your Form on behalf of the Member Federation/Area Association:

List any current or past positions (with date(s)) of the Applicant in the Member Federation/Area
Association:

2.2. SIGNATURES
2.2.1 APPLICANT SIGNATUREI DECLARE that the information included in this Application Form concerning my application for aposition as a World Athletics Commission Member is accurate and complete.
I confirm I have read, understood and will comply with World Athletics Constitution and its Rules,
including the Integrity Code of Conduct.
(please tick if true)
I understand that World Athletics, will hold and process my personal data in order to fulfil thelegitimate interests of World Athletics in considering my application, which, if successful,
may include publishing personal data on the World Athletics website and/or otherwise providing thisdata to Member Federations and other interested parties around the world, and I consent to World
Athletics doing so.
(please tick if true)
Please fill in and sign
Signature*
NameDate (dd/mm/yyyy)
Place (Town/City, Country)*A digital signature is acceptable4

2.2.2 MEMBER FEDERATION / AREA ASSOCIATION SIGNATURE (only complete if Application isto be endorsed)
As the most senior officer of the Member Federation or Area Association*, I confirm that theMember Federation/ Area Association, by resolution of its Board, Executive Committee orequivalent body, endorses the application of this Applicant.
*Where the Applicant is the most senior officer of the Member Federation or Area Association, thismust be signed by the next most senior officer of the Member Federation or Area Association.
Please fill in and sign if required.
Signature**NameDate (dd/mm/yyyy)
Place (Town/City, Country)**A digital signature is acceptable
Member Federation/Area Association Stamp (if available)5www.worldathletics.org@WorldAthletics©World Athletics 2023.
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