INTERNATIONAL WATER RESOURCES ASSOCIATION

Executive Office: 51 Rue Salvador Allende - 92027 Nanterre Cedex - France

Tél.: +33 (0)1 41 20 16 28 - Email:

www.iwra.org

Nomination form for IWRA Hori Fund grant

IWRA Member (person who is nominating)

Name ______Phone: ______

Address ______Fax: ______

______Email: ______

______Country: ______

Candidate Information

Name ______Phone: ______

Address ______Fax: ______

______Email: ______

______Country: ______

Supporting Statement. On an accompanying page, please explain and support your nomination of this candidate. Make sure to address the criteria for awardees, i.e., that they (a) have a clear financial need; (b) are from the OECD list of developing countries; (c) are from countries or regions that are significantly underrepresented in IWRA membership; and (d) contribute service to IWRA or demonstrate a potential to increase membership numbers in their country or region. If any of these criteria do not apply to the candidate, please provide a justification for a waiver.

All nominations must be submitted to the Executive Director of IWRA:

Mr. Callum Clench

International Water Resources Association

WRA Executive Office

51 Rue Salvador Allende

92027 Nanterre Cedex, France

Email:

Phone: +33 (0)1 41 20 16 28