Nomination – Contribution to Mining

NOMINATION FORM – CONTRIBUTION TO MINING

All fields marked with * must be completed

YOUR DETAILS

Name:*

Email:*


NOMINEE DETAILS

Name:*

Position title:

Company:*

Number of years with company:*

Street address:*

Suburb:*

State:*

Postcode:*

Phone:*

Email:*


AWARD DETAILS

Please write a summary about the career highlights and achievements of the nominee:*
Suggested maximum 200 words

Please supply a summary of the business they work for:*
Suggested maximum 300 words

Please write a brief overview of the nominee's job function and responsibilities:*
Suggested maximum 300 words

Please indicate how the nominee has impacted on business success and added value to the business:*
Suggested maximum 300 words

Please outline the nominee's contribution to the wider mining community:*
Suggested maximum 300 words

You may attach up to three (3) supplementary files (photographs, diagrams, maps, etc.):
1.
2.
3.

How did you hear about the Prospect Awards?
 Australian Mining magazine

 www.australianmining.com.au

 Word of mouth
 Other (please specify)


TERMS & CONDITIONS

1. By submitting a nomination, you give permission for Australian Mining to publish information about the nominee and their employer.
2. You also consent to Australian Mining and parent company Prime Creative Media collecting your information, and to receiving information on other events and publications. Your contact information will not be disclosed to any third parties.
3. If nominating on behalf of another company or person, Australian Mining and Prime Creative Media relies that you have authority to act on behalf of this company or person to submit their information and consent to the terms & conditions on their behalf.
 Yes, I accept the terms & conditions