NOMINATION FORM

Please fill out the form below. You may nominate yourself, your organisation, another individual or another organisation. Please take the time to read the Rules of Entry. You may make multiple nominations.

Please be aware that where applicable to the specific award the nominees must be a member in good-standing of either the Civil Mediation Council, Family Mediation Council or the College of Mediators at the date of entry. Learn more about the Judging Criteria.

MAKE YOUR NOMINATIONS

Your Full Name or Organisation*

Contact Name (if Organisation)

Email Address*

Phone Number

Who would you like to nominate?* Who would you like to nominate?* Myself My organisation Another individual Another organisation

Which organisation is the nominee a member of?* Which organisation is the nominee a member of?* Civil Mediation Council College of Mediators Family Mediation Council None of the above

Full Name Nominee*

Contact Name Nominee (if Org)

Postal Address Nominee

Email Address Nominee*

Phone Number Nominee

Nomination Category*

Please provide evidence in no more than 1000 words. (to be amended)

Please provide a 60-word biography of yourself or your organisation*

Please attach a picture of yourself* Please attach a picture of yourself*

Please attach the logo of your organisation* Please attach the logo of your organisation*

Disclaimer* Disclaimer* I hereby acknowledge that.... (tba)

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