Select the post that you seek nomination* —Please choose an option—President Elect (2022-2023) (Will automatically become President for the year2023-2024)President for period (2022-23)Vice President (2022-2023)Hon. Secretary (2022-25)Hon. Treasurer (2022-25)Members for the Governing Body (2022-24)Zonal Chairperson – North Zone (2022-24)Zonal Chairperson – South Zone (2022-24)Zonal Chairperson – East Zone (2022-24) Those desiring to contest for the posts of ‘President elect’ and President should have been elected members of the Governing Body for at least two tenures of office; Those contesting for the post of President Elect and President, should in addition have been awarded Fellowship of the Indian Chest Society.(FICS) A person who has held the post of the President will not be eligible to contest in any subsequent elections for posts in the Governing Body. Those desiring to contest for the posts of ‘President elect’ and President should have been elected members of the Governing Body for at least two tenures of office; Those contesting for the post of President Elect and President, should in addition have been awarded Fellowship of the Indian Chest Society. (FICS) A person who has held the post of the President will not be eligible to contest in any subsequent elections for posts in the Governing Body. Those contesting for the post of ‘Vice-President’ should have been elected members of the Governing Body for at least one tenure of office; Life members desiring to contest for the posts of Secretary, should have been elected members of the Governing Body for at least two tenures of office; Life members desiring to contest for the posts of Treasurer, should have been elected members of the Governing Body for at least two tenures of office; For all posts of the Governing Body, the contestants should have been members of the Society for at least five continuous years and should have attended at least 1 Annual General Body meeting in the preceding 3 Yrs; Those contesting for the post of ‘Zonal Chairperson’ should be domiciled in any of the states within the respective Zone throughout their tenure; Those contesting for the post of ‘Zonal Chairperson’ should be domiciled in any of the states within the respective Zone throughout their tenure; Those contesting for the post of ‘Zonal Chairperson’ should be domiciled in any of the states within the respective Zone throughout their tenure; Name* Date of Birth* Gender* SelectMaleFemale Email* Mobile* Primary Address* Primary Work Affiliation* ICS Membership ID* Please mention the approx year of Obtaining ICS Membership?* I have been a member of the ICS for more than 5 continuous years?* YesNo Have You Been Awarded Fellowship of the Indian Chest Society(FICS) ?* YesNo If Yes (Year of Award) List governing body posts held in ICS: Post 1: —Please choose an option—N/APresidentVice PresidentHon.SecretaryHon.TreasurerMembers for the Governing BodyZonal Chairperson – North ZoneZonal Chairperson – South ZoneZonal Chairperson – East ZoneZonal Chairperson – West Zone From: To: Post 2: —Please choose an option—N/APresidentVice PresidentHon.SecretaryHon.TreasurerMembers for the Governing BodyZonal Chairperson – North ZoneZonal Chairperson – South ZoneZonal Chairperson – East ZoneZonal Chairperson – West Zone From: To: Post 3: —Please choose an option—N/APresidentVice PresidentHon.SecretaryHon.TreasurerMembers for the Governing BodyZonal Chairperson – North ZoneZonal Chairperson – South ZoneZonal Chairperson – East ZoneZonal Chairperson – West Zone From: To: Post 4: —Please choose an option—N/APresidentVice PresidentHon.SecretaryHon.TreasurerMembers for the Governing BodyZonal Chairperson – North ZoneZonal Chairperson – South ZoneZonal Chairperson – East ZoneZonal Chairperson – West Zone From: To: Post 5: —Please choose an option—N/APresidentVice PresidentHon.SecretaryHon.TreasurerMembers for the Governing BodyZonal Chairperson – North ZoneZonal Chairperson – South ZoneZonal Chairperson – East ZoneZonal Chairperson – West Zone From: To: Attendance to the AGM meetings in the past 3 years, (tick the appropriate response): 1. Napcon 2021 (held at Varanasi in Mar 2022):YesNo 2. Napcon 2020 (Virtual, in Jan 2021): YesNo 3. Napcon 2019 (held at Cochin in Nov 2019): YesNo Name of the Life Member Proposer* Membership number of Life Member Proposer* Phone No of Life Member Proposer* E-Mail of the Life Member Proposer* Name of the Life Member Seconder:* Membership number of the Life Member Seconder* Phone No of the Life Member Seconder* E-Mail of the Life Member Seconder* Life member cannot propose or second more than one contestant’s nomination, however they may propose or second the same contestant for multiple posts. Undertaking: The above information is true to the best of my knowledge. I commit to the following:* I shall accept the decision taken by the Returning officer on my eligibility to contest in the election I shall refrain from adopting corrupt practices and follow campaign practices If the critical information I provided is false, I understand I could be disqualified If elected, I commit to working towards the fulfilment of the objectives of ICS and uphold its constitution and bylaws I will submit a brief introduction of myself with a passport size picture within the provided deadline, to the Election office, so that it could be displayed for the benefit of the voting members. I am aware of the ICS constitutional clause that : Contesting members should not hold a Governing Council post in National College of Chest Physicians-NCCP, during his tenure, to avoid conflict of interest. If anyone contesting is found to be in holding such a post, he/she shall be summarily disqualified. Governing Body members taking up office should provide an undertaking to this effect. If this information is known after they have been elected to office, they would be asked to step down and nominations would be called to fill their post in the following election, regardless of the duration of their tenure. In this matter, the decision of the Governing Body shall be final; I will pay the required amount of INR 5000/- as fees with my application. Signature (Write your full name)* Date of Submission*
