We are now accepting nominations for 2017
(Nominations close on 14th July 2017)

Nominate

GPBuddy Awards Nomination Form

All entries must be submitted no later than Friday 28th July 2017

Choose your category..

The Nominator
*Title(Mr/Ms/Dr):
*First Name:
*Surname:
*Place of Work:


*Position:
IMC No (if relevant):
*Address line 1:
Address line 2:
Address line 3:
*Contact Number:
*Contact Email:
The Nominee
Same as above
*Title(Mr/Ms/Dr/Prof):
*First Name:
*Surname:
*Place of Work:


Does the nominee know that you are nominating?
Describe the Nominee:
Why Should the Nominee win this Award?
Upload Supporting Material:
Allowed files type: Images/Doc/PDF, Max file size: 2MB
I agree to the Terms & Conditions
* these fields are mandatory

The Nominator
*Title(Mr/Ms/Dr):
*First Name:
*Surname:
*Place of Work:


*Position:
IMC No (if relevant):
*Address line 1:
Address line 2:
Address line 3:
*Contact Number:
*Contact Email:
The Nominee
Same as above
Project / Initiative Name:
*Title(Mr/Ms/Dr/Prof):
*First Name:
*Surname:
*Place of Work:


Does the nominee know that you are nominating?
Describe the Initiative:
Why Should the Initiative win this Award?
Upload Supporting Material:
Allowed files type: Images/Doc/PDF, Max file size: 2MB
I agree to the Terms & Conditions
* these fields are mandatory