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Surgeon Award
Awarded to a female individual who has made an outstanding contribution to the surgical field.
ENTRANT`S DETAILS
Title:
First Name of Nominee:
Last Name of Nominee:
Job Title:
Company:
Email Address:
Company Address:
Telephone No
Mobile:
Date of Birth (DD-MM-YYYY):
Nationality:
Ethnic Origin:
IF YOU ARE NOT THE ENTRANT, PLEASE FILL IN YOUR DETAILS
Title:
Full Name:
Job Title:
Company:
Email Address:
Company Address:
Telephone No
Mobile:
THE QUESTIONS
1. Please outline why the nominated individual/organisation should be considered for the award? (200 words max)
*
2) Provide relevant information on the nominee:Testimonials Achievements over the years, in most particular the past year (most recent first) Honours and awards (most recent first) (300 words max)
*
3) List, all qualifications and institutions where the nominee studied: (most recent first) (200 words max)
*
4) Provide a brief biography of the nominated individual/organisation (200 words max)
*
5) Provide a summary of the nominee's approach to gender and ethnic diversity and its impact (250 words max)
*
I confirm that I have read and understood the terms and conditions and agree to abide by them.
