Nomination Form

 

NOMINATION FORM

All fields marked with * must be completed

YOUR DETAILS

Name:*

Email:*


NOMINEE DETAILS

Name:*

Company:*

Position title:

Street address:*

Suburb:*

State:*

Postcode:*

Phone:*

Email:*


AWARD CATEGORIES & DETAILS

Please select which categories you are nominating for (up to three):*
Social Leader of the Year
Rising Star of the Year
Business Development Manager of the Year
Industry Advocacy Award
Safety Advocacy Award
Mentor of the Year
Excellence in Manufacturing
Excellence in Mining
Excellence in Road Transport
Excellence in Engineering

Please provide a summary of the career highlights of the nominee:*
Suggested maximum 200 words

How has this nominee overcome adversity and challenged in the industry?*
Suggested maximum 300 words

What separates this nominee from others in the industry?*
Suggested maximum 300 words

You may attach up to three (3) supplementary files (photographs, diagrams, maps, etc.):
Combined file size must not exceed 10MB
1.
2.
3.

How did you hear about the Women in Industry Awards?
Magazine (please specify)

Website (please specify)

Word of mouth
Other (please specify)


TERMS & CONDITIONS

1. By submitting a nomination, you give permission for Prime Creative Media to publish information about your company and project.
2. You also consent to Prime Creative Media collecting your information, and to receiving information on other events and publications. Your contact information will not be disclosed to any third parties.
3. If nominating on behalf of another company or person, Prime Creative Media relies that you have authority to act on behalf of this company or person to submit their information and consent to the terms & conditions on their behalf.
Yes, I accept the terms & conditions