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* 1. First name

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* 2. Surname / Last name / Family name

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* 3. E-mail address

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* 4. ECTA Membership number

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* 5. Country name

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* 6. Please specify what your expertise in IP is and the type of work you mostly carry out in IP.

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* 7. Please specify (previous) Committee affiliation, what projects you were involved in, etc (if applicable)

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* 8. Please confirm that you have read the following documents:

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* 10. Please indicate your second choice Committee (if first choice is not available)

In case you wish to apply for any exception from the rules of the ECTA General Committee Elections, kindly fill in this Application Form accordingly and contact the Chair(s) of the respective Committee(s) at the same time and not later than on 5 March 2021. Any and all exceptions are subject to the approval of the ECTA Board of Directors.

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