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    WDTA Academician Application Form

    1.Candidate Information
    Full Name
    Email
    Gender
    Date of Year
    Nationality
    Position / Title
    Organization
    Work Address (city)
    Field of Expertise (select one or more)
    2.Achievements & Recognition
    Key Awards / Honors (include international awards):
    Major Publications / Patents / Projects:
    Leadership Roles / Memberships in Academies:
    3.Nomination Information (if applicable)
    Nominator’s Name:
    Nominator’s Position / Organization:
    Relationship to Candidate:
    Email / Contact:
    4.Supporting Documents (upload)
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    I hereby declare that the information provided is accurate and complete to the best of my knowledge. I understand that submission of this form does not guarantee election as a WDTA Academician.
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