The Tammy Axelsen Lifetime Achievement Award Nomination Form

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. All fields marked as “Required” must be completed before you can submit your nomination.

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This field is for validation purposes and should be left unchanged.

NOMINEE DETAILS (person you would like to nominate)

Nominee's Name(Required)

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(Required)

Enter Email Confirm Email

Nominee's postal address (line 1)(Required)

Nominee's postal address (line 2)

Town/City(Required)

State/Province(Required)

Postcode(Required)

Country(Required)

Detail the nominee's outstanding service to the Print Disability Sector(Required)

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(Required)

First Last

Nominator's Organisation

Nominator's 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(Required)

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