$name

Nomination Form

Please fill in the fields in the nomination form below. We advise you to read through the form first, prepare any longer answers in a word processing programme such as Microsoft Word and then copy and paste them into the form.

 

Name of Award for which the Nominee or Nominees is or are Proposed
*
Nominee Name
*
Nominee Address
Nominee Website Address
A summary of the Nominee or Nominees contribution to the field of the Award
*
Name of Proposer
*
*