CANDIDATE FORM 2017

ESPNIC ELECTIONS:

  • Respiratory- Chair and Deputy Chair
  • Ethics- Chair and Deputy Chair
  • Cardiovascular dynamics- Deputy Chair
  • Cardiac ICU and Mechanical Circulatory Support- Deputy Chair
  • Infection, systemic inflammation and sepsis- Chair and Deputy Chair
  • Neuro critical care- Chair and Deputy Chair
  • Metabolism, endocrinology and nutrition- - Chair and Deputy Chair
  • Pharmacology- Chair
  • Resuscitation- Chair and Deputy Chair
  • Quality improvement, patient safety and long term outcomes- Chair and Deputy Chair

Please kindly fill in the form in BLOCK capital letters.

CONTACT DETAILS

First name(s) Indicate first name(s) Last name(s): Indicate last name(s)

Address: Indicate work or private address

E-mail: Indicate email address

 Work phone: Indicate work phone number

 Mobile phone: Indicate mobile phone number

TERMS OF REFERENCE

Section Chair

  • Member of Scientific Affairs Division
  • Represent section at Scientific Affairs Division
  • Facilitate task force (communication and work flow)
  • Provide content for web page on ESPNIC society website
  • Provide content for monthly newsletter
  • Provide progress reports for each EC meetings
  • Provide yearly plan, performance indicators and budget (if applicable) for revision to EC
  • Submit work plan and budget for following year to EC for approval prior to congress
  • Approval of the work plan performance indicators and budget (if applicable) during face to face meeting during congresses as per below timeline:

Submit proposals to ESPNIC Executive Committee in July for following year

Review by ESPNIC Executive Committee within 4 weeks

  • Support ESPNIC office in organisation of face to face section meetings during congresses (provide agenda and required format of the meeting)

Term of office: 3 years, renewable once

Section Deputy Chair

  • Member of Scientific Affairs Division
  • Member of the Professional Development Affairs Division
  • Support Chairman in all duties (as mentioned above):
  • Represent section Scientific Affairs Division
  • Facilitate task force (communication and work flow)
  • Provide content for web page on ESPNIC society website
  • Provide content for monthly newsletter
  • Provide progress reports for each EC meetings
  • Provide yearly plan , performance indicators and budget (if applicable) for revision to EC
  • Support ESPNIC office in organisation of face to face section meetings during congresses (provide agenda and required format of the meeting)
  • Represent Chairman when (s)he is unavailable

Term of office: 3 years, renewable once

Meetings format

1 face to face meeting during congresses (scheduled in the general meetings schedule)

Conference calls (can be organised with the ESPNIC Office support via Swisscom or Skype)

Please select the position you are applying for (tick the box):

Respiratory- Chair

Respiratory- Deputy Chair

Ethics- Chair

Ethics- Deputy Chair

Cardiovascular dynamics- Deputy Chair

Cardiac ICU and Mechanical Circulatory Support- Deputy Chair

Infection, systemic inflammation and sepsis- Chair

Infection, systemic inflammation and sepsis- Deputy Chair

Neuro critical care- Chair

Neuro critical care- Deputy Chair

Metabolism, endocrinology and nutrition- Chair

Metabolism, endocrinology and nutrition- Deputy Chair

Pharmacology- Chair

Resuscitation- Chair

Resuscitation- Deputy Chair

Quality improvement, patient safety and long term outcomes- Chair

Quality improvement, patient safety and long term outcomes- Deputy Chair

Personal statement (250 words max.)

TYPE TEXT HERE

DISCLAIMER

I herewith confirm that I am not currently being investigated by my regulatory body for fitness to practice incident.

Date: ………………………

Signature:…………………………………………

PROCESS

Submit your application, CV, personal statement, and photo byemailto the ESPNIC Administrative Office y1 September 2017.

Elections will take place 15 September 2017- 15 October 2017. Winners will be announced at the end of October 2017.

Please note that your application should be sent with the following information:

  1. This completed candidate form
  2. A passport style photo in jpg format with the dimensions 200 x 200 pixels
  3. Your CV

Your candidature will be considered onlyupon receipt of all documents.
***IMPORTANT***
Please note only members in “good standing” (paid members) will be considered for candidature. Should you have not yet renewed your membership we kindly urge to do so!