Nominee Details

Nominee First Name*

Nominee Last Name*

Nominee Company Name*

Award Submission

Brief Summary (30 words or less)*

Please provide a short summary of your entry

250 Word Entry*

Please paste or type your 250 word entry here. Entries that exceed the word limit will be excluded from the judging process.

Supporting document*

Please upload a single document of supporting information - up to a maximum of six A4 pages long.

Headshot*

Please upload your head shot

First name*

Last name*

Email*

Company name*

Street address

City

Country/Region

State/Region

Phone number*