Biosafety Advisory Council Secretariat O./ref.: WIV-ISP/41/BAC/2012_0764 Nomination form for the expert group ‘Transgenic plants’ Version September 2012 Please return the completed and signed form together with a copy of your CV to the SBB by post, fax or email Address: Biosafety and Biotechnology Unit, Scientific Institute of Public Health, rue Juliette Wytsmanstraat, 14 - B 1050 Brussels – BELGIUM Email: [email protected] Last name : .............................................................................................................................................. First name : .............................................................................................................................................. Gender: ...................................... Year of birth: ........................ Identification number of the national register: ................................................... Commitment please tick and delete where appropriate O I want to participate/to continue participating in the Experts group ‘Transgenic plants’. Please complete the form below. O I don't want to participate in the Experts group 'Transgenic plants' any longer. Contact details Title(s): O Prof. O Dr. O Eng. Institution : ........................................................................................................................................... Department : ....................................................................................................................................... Address : ............................................................................................................................................. tel. : ..................................................................................................................................................... email : .................................................................................................................................................. Payment please fill in the number of the personal account to which reimbursements should be transferred IBAN account number : ....................................................................................................................... account holder name : ........................................................................................................................ account holder address : ..................................................................................................................... Wetenschappelijk Instituut Volksgezondheid | Institut Scientifique de Santé Publique Dienst Bioveiligheid en Biotechnologie | Service Biosécurité et Biotechnologie Rue Juliette Wytsmanstraat 14 | B-1050 Brussels | Belgium T + 32 2 642 52 11 | F + 32 2 642 52 92 | [email protected] | www.bio-council.be WIV-ISP/41/BAC_2012_0764 p1/3 Expertise This section allows you to specify your main area(s) of expertise for contribution to the Expert Group. Please indicate only the particular subjects in which you have specialized expertise. Research disciplines agronomy cultivation techniques harvesting techniques management techniques volunteer management biological control weed science sustainable development molecular characterisation DNA/RNA/Protein analysis profiling techniques epigenetics post-translational modification inheritance and genetic stability omics taxonomy horticulture ornamental horticulture fruit growing vegetable growing ecology population genetics ecotoxicology hybridization invasiveness plant-insect interactions plant-soil interactions biogeochemical processes biodiversity agro-ecosystems agro-biodiversity nature conservation social ecology forest ecosystems breeding techniques conventional breeding genetic modification biotic stress resistance bacterial resistance fungal resistance insect resistance nematode resistance virus resistance plant biology morphology growth reproduction multiplication/propagation development metabolic pathways diseases entomology phytopathology phytopathogenic bacteria phytopathogenic fungi phytopathogenic viruses phytopathogenic nematodes phytopharmacy (bio)statistics other: Engineered traits male sterility altered characteristics improved nutritional quality altered growth/development lignin or cellulose altered structure altered flower colour abiotic stress tolerance cold tolerance drought tolerance metal tolerance salt tolerance production of pharmaceutical compounds industrial compounds biofuels herbicide tolerance phytoremediation other: continues next page Wetenschappelijk Instituut Volksgezondheid | Institut Scientifique de Santé Publique Dienst Bioveiligheid en Biotechnologie | Service Biosécurité et Biotechnologie Rue Juliette Wytsmanstraat 14 | B-1050 Brussels | Belgium T + 32 2 642 52 11 | F + 32 2 642 52 92 | [email protected] | www.bio-council.be WIV-ISP/41/BAC_2012_0764 p2/3 Biosafety research on GMOs persistence and invasiveness horizontal gene transfer outcrossing to wild relatives effects on target species effects on non-target species impact on biogeochemical processes impact of farming practices impact on biodiversity post-release monitoring insect-resistance management risk analysis biological confinement strategies marker-free selection methods other Plant species alfalfa Arabidopsis thaliana banana beet (fodder beet) beet (sugar beet) chicory cotton duckweed (Lemna) hop maize oilseed rape other Brassicaceae poplar potato rice soybean tobacco tomato wheat and other cereals algae bryophytes grasses flowers for ornamental use horticultural plants and trees forest trees fruit trees other: Other relevant disciplines: ……………………………………………………………………………. …………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………….. I hereby confirm that the above information is correct. I have no objection to the fact that my name and affiliation will be made publicly available on the Biosafety Council website. Date : Signature : Copy of CV added: Additional comments ............................................................................................................................................................ ............................................................................................................................................................ Wetenschappelijk Instituut Volksgezondheid | Institut Scientifique de Santé Publique Dienst Bioveiligheid en Biotechnologie | Service Biosécurité et Biotechnologie Rue Juliette Wytsmanstraat 14 | B-1050 Brussels | Belgium T + 32 2 642 52 11 | F + 32 2 642 52 92 | [email protected] | www.bio-council.be WIV-ISP/41/BAC_2012_0764 p3/3