The Tammy Axelsen Lifetime Achievement Award Nomination Form

The Tammy Axelsen Lifetime Achievement Award Nomination

This award is for outstanding service by an individual to the Print Disability Sector, the nominee should have had some connection with Round Table. Please provide as much detail as possible.

NOMINEE DETAILS (person you would like to nominate)
Nominee's Name*
First Last
Nominee's work phone number
Including area code and, if outside Australia, country code.
Nominee's home phone number
Including area code and, if outside Australia, country code.
Nominee's mobile phone number
Including country code.
Nominee's email address and confirmation of email address*
Enter Email Confirm Email
Nominee's postal address (line 1)*
Nominee's postal address (line 2)
Town/City*
State/Province*
Postcode*
Country*
Detail the nominee's outstanding service to the Print Disability Sector*
Please write at least 100 words. If you require more space please attach files below.
Additional nominee information
Up to 4 files (maximum 200MB per files) may be added if you wish to supply additional information to support your nomination. File types accepted are: .pdf, .doc, .docx, .txt
Drop files here or

Accepted file types: pdf, doc, docx, txt, docx, Max. file size: 200 MB, Max. files: 4.
NOMINATOR (your details)
Nominator's Name*
First Last
Nominator's Organisation and Position
Nominator's telephone number
Including area code and, if outside Australia, country code.
Nominator's work telephone number
Including area code and, if outside Australia, country code.
Nominator's mobile telephone number
Including country code.
Nominator's email address and confirmation of email address*
Enter Email Confirm Email
REFEREE (Optional)
This information will help the selection committee if your nominee is shortlisted. This person may be contacted for further information about the nominee.
Referee's organisation/position
Referee's name
First Last
Referee's mobile phone number
Including country code.
Referee's home phone number
Including area code and, if outside Australia, country code.
Referee's work phone number
Including area code and, if outside Australia, country code.
Referee's email address and confirmation of email address
Enter Email Confirm Email
APPLICATION SUBMISSION
Date*

Day
Month
Year