NOMINATION FOR THE HOUGHTON TRUST LECTURER 2013
This form should be completed in black typescript and sent to:
Dr. Francois-Xavier Le Gros
Merial, Lyon Gerland Laboratory
254 rue Marcel Mérieux, BP 39I
69007 Lyon
FRANCE 		For official use only

Ref:

Received:

Action:
NAME OF NOMINEE

Family name:

Given name(s):

Title:

 NATIONALITY/CITIZENSHIP


DATE OF BIRTH
WORK ADDRESS OF NOMINEE



Tel:

EMail:

 ACADEMIC QUALIFICATIONS
(Degrees, Diplomas, etc)
BRIEF STATEMENT OF CAREER OF NOMINEE (Only use this space - no additional sheets)
CURRENT SPECIALIZATION (Only use this space - no additional sheets)
PRIZES, HONOURS ETC. RECEIVED TO DATE BY NOMINEE



PUBLICATIONS

Please append a complete list of all the scientific publications of the nominee
CASE FOR THE AWARD (please make full use of this section to justify the nomination)
Indicate the advances made and the effect that they have had on scientific thought, on the poultry industry etc.
Name and signature of Bureau member/corresponding secretary/individual WVPA member preparing the nomination
NAME:
SIGNATURE:


 DATE:
ADDRESS of Bureau member/corresponding secretary/individual WVPA member for correspondence


This nomination must be sent to Dr. Francois-Xavier Le Gros (address on page 1)
by 30 June 2011.