Board of Governors (BG)
  and Advisory Council (AC)
  Nomination Form (2020)

For Terms Beginning January 2021


    Submission deadline: Tuesday, 20 October 2020    

Directions: Please use this form to nominate a PTC Member for election to the Board of Governors (BG) or Advisory Council (AC). Self-nominations are welcome.

We recognize that the following questions will take a few minutes of your time to answer, and in our busy industry, time is precious. However, these details are very important and help ensure that the Succession Planning Committee (SPC) has each nominee’s full details.

We encourage you to review the following documents (PDF) for additional information:
    Desired Qualifications for PTC Leadership Candidates
    Essential Rules and Guidelines for PTC Leadership Elections
    Information Regarding the PTC Board of Governors (BG)
    Information Regarding the PTC Advisory Council (AC)
    Continuing and Incumbent Board of Governors (BG) and Advisory Council (AC) Members by Category

Nomination Form

Note: An asterisk (*) denotes a required field.

Candidate Photograph*

5" x 7" 1500 x 2100 pixels
Please note only .jpg or .gif file formats and files less than 7 megabytes in size will be accepted.

Nomination Type*

Board of Governors (BG)
Advisory Council (AC)

1. Nominee’s Personal Details

Name*:
Country of Residence*:
Contact Information
Telephone (+ country code)*:
Email*:
LinkedIn Public Profile URL:

2. Nominee Member Organization's Details

(if other than Individual Member)

     
Organization Name:
Organization Address Used for Membership
Street Address:
City:
State/Province:
Zip Code/Postal Code:
Country:
 
Nominee's Title in Organization:

3. Nominee's Professional Background

(150 words or less):

4. Nomination Category*

If the Organization's physical address (#2 above) is not geographically located within the nomination category selected (#4 above), please provide justification for your selection (e.g., a website address for the subsidiary/branch/satellite office located within the selected nomination category or other justification for nomination outside of member organization's resident region).

5. Nominator’s Contact Information

(if this is NOT a self-nomination)

Name:
Contact Information
Telephone (+ country code):
Email:
LinkedIn Public Profile URL:

6. Is the Nominee aware of nomination and willing to serve, if elected?*

Yes
No

7. Explain how the Nominee proposes to represent the interests and viewpoints of their region (selected nomination category) or business segment.

(150 words or less)

8. Candidate Statement*

(this must come directly from the nominee, i.e., in the nominee's own words)
(150 words or less)


Please review your entries prior to submitting this form. The person submitting a nomination will receive an email confirmation. Please contact us at nominations@ptc.org if you do not receive an email, to ensure we received your nomination.