Please complete the nomination form no later than 9 January 2023

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* Name of person making the nomination:

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* Role of person making the nomination:

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* Contact e-mail address of person making the nomination:

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* Member Association (or exceptionally other organisation) name:

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* Country:

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* Name of the nominee:

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* Work institution of nominee:

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* Nationality of nominee:

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* Date of birth of nominee:

Date

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* Email address of nominee:

Please submit the documents requested at each submission point below. 
Please note: 
  • Supporting documents should be in the format specified currently Pdf, Doc, Docx, PNG, JPG, JPEG, GIF
  • If documents are over length they will be returned and the additional content will not be reviewed by the Awarding Committee

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* 1. A statement (not to exceed 1,000 words) from the MA (or other nominating institution) addressing how the nominee has met the criteria for the award, signed by the President, CEO or other appointed officer:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
2. Supporting documentation which may include (Note: it is not obligatory to upload a document for each type of documentation mentioned):

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* (a)    Curriculum Vitae not exceeding 4 pages in length

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* (b)    Letter of recommendation #1

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* (c)    Letter of recommendation #2

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* (d)    List of publications and presentations at national and international conferences

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* Please tick to confirm the following statement:

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