26 January 2018

Executive Committee elections 2018:

nomination form
Thank you for standing for election to the EMSP Executive Committee!

For your application to be valid, please fill-in all parts of the below form. Do not forget to sign the
form and have it countersigned by an authorised Senior Executive or Member of your Board
confirming that your society supports your nomination.
Please scan and email the form to Andreea Antonovici (andreea.antonovici@emsp.org) by 15 March
2018. Nominations received after this date cannot be considered.

1. Name of Member Society

Multiple Sclerosis Society from Moldova

2. Full name and position of nominee

(e.g. Dr Tania Gregory, Secretary General; Mr Peter van Halen, MS Patient Committee
Representative)

Verbnii Alina, president MSSM

3. Position on Executive Committee nominee is standing for

Position Tick relevant box

Ordinary member

President
×
Vice President

Treasurer
4. Contact details of nominee

Postal address: Chisinau, MD- 2045

Email: ssmmoldova@gmail.com

Phone: +37369571886

5. Biography
Please provide a short biography (maximum 500 words)

6. Skills and experience

What skills or expertise do you have Evidence of relevant experience,

that could bring value to EMSP Board qualifications or membership of
(please tick all that apply)? professional bodies relating to the skills or
expertise identified
1. Strategic management and planning ×
2. Project management ×
3. Business or Financial expertise
(accountancy, investment, etc.)
4. Legal expertise
5. Governance
6. Fundraising ×
7. Communications (Public relations,
marketing, branding, information
provision)
8. Digital and social media ×
10. Advocacy and campaigning ×
11. Organisational capacity building ×

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Executive Committee elections 2018: nomination form
 5. Supporting statement

Please provide a statement (not more than 750 words), explaining why you are standing for election
to the EMSP Executive Committee; what you hope to contribute to EMSP and in turn, to bring back
to your organisation and its members.

I agree to stand for election to the EMSP Executive Committee as a representative of the
[insert name of the society] MS Society.

Full name of applicant

Position
Date
Signature

I [insert name of authorised MS Society Representative] confirm that the above person is
the selected nominee to the EMSP Executive Committee from this Society.

Full name of authorized MS society

representative
Position
Date
Signature

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Executive Committee elections 2018: nomination form