Are you nominating a candidate, or are you nominating yourself?

If you are nominating SOMEONE ELSE, what is your relationship with, or connection to, the Candidate?

If you are nominating SOMEONE ELSE, which is the best way to contact you?

Your Phone Number

Your Mobile Phone Number

Your Email Address:

Your Mailing Address:

Full Name Of PERSON BEING NOMINATED ("the Candidate"):

Is the Candidate aware that they are being nominated for this award?

What is the Candidate's gender?

When it becomes necessary, which is the best way for the Club to contact the Candidate?

Candidate's Phone Number:

Candidate's Mobile Phone Number:

Candidate's Email Address:

Candidate's Mailing Address

What is the approximate age of the Candidate?

Please attach Candidate's photo (head & shoulders) if available.

What is the name of the company, organisation or entity through which the candidate undertakes their VOCATION?

What is the nature of the Candidate's vocational (work) achievement(s)?

In what industry, trade or profession is the candidate engaged?

How long has the candidate worked in this industry, trade or profession?

Which organisation(s) has the Candidate worked with/for to deliver their COMMUNITY SERVICE? 

How long has the Candidate undertaken their community service?

Has the candidate's community service been continuous throughout this period?

Was/is the Candidate's community service performed on a voluntary basis?

Has the Candidate received any other formal recognition for their community service?

If "Yes" to the previous question, what was the nature of that formal recognition and when, and by whom, was it awarded?

Please attach here the Candidate's CV: 

If considered necessary, please attach here  a document containing any further material in support of the nomination:

Please add any further comments in support of the nomination of this Candidate.