EAACI Elections

New elections submission

Ethics Committee board member 2020-2022

Personal information
  • Step 1 of your application form is for our records only. It may be used by our Election Committee to review eligibility criteria and our HQ staff for correspondence purposes only
  • During voting processes, page one of your application will be removed
  • Any information provided on following pages must not include any personal data (date of birth, address, email, telephone numbers)
Family Name
First Name
Telephone
Email
Submission information
Family Name
First Name
Year of Birth
Country
Previous EAACI collaborations or related activities (with dates)
Motivation statement (max 500 words)
Previous professional activities (last five years only)
Upload your CV here

Please note:
Your CV may be used during online voting processes, for data protection please therefore do not include any personal information (date of birth, address or telephone numbers).

Declaration of Interests

DECLARATION OF INTERESTS - DISCLOSURE REQUIREMENTS

1. Financial Interests
Disclosure of information about all organizations and commercial interests, other than their employer or their practice, from which the individual or a member of their immediate family or household receive annual remuneration or gifts in any amount (including grants, honoraria, consulting fees, etc) or hold shares.

2. Research Interests
Disclosure of information about all organizations which support research projects for which the individual or a member of their immediate family or household serve as an investigator.

3. Organizational Interests
Disclosure of information about positions (paid or voluntary) in organizations, other than the EAACI.

4. Other Interests
Any additional interests of the individual or members of their immediate family or household that would be judged by a majority of their peers to be more than casual and/or likely to impact on their ability to exercise independent judgement. This includes any financial interest in or relationship with any manufacturer of a relevant commercial product, and financial interest or relationship with any organization that provides commercial support to EAACI educational activities. If in doubt disclose or seek advice from the Election Committee.


I confirm that I have read and fully understand the rules on Declaration of Interests and hereby declare:
I confirm that, to the best of my knowledge:
  • The information contained in this declaration is complete and accurate
  • I am not aware of any conflicts (if any), other than those contained in this declaration
I undertake to:
  • Review this declaration at least once in every 12-month period and update if necessary
  • Update this declaration as and when my circumstances change
  • Declare promptly any conflict that arises in the future
Date

Name
Signature