NOMINATION FOR THE LIFETIME ACHIEVEMENT / MOST OUTSTANDING ACHIEVEMENT AWARD
INSTRUCTIONS:
- This nominating application needs to be submitted by a trade or professional association with the consent of the nominee
- An updated CV of the nominee must be attached/forwarded to the application and email to the nbqsaapps@gmail.com
- Include clear reference and contact details to verify the achievements of the nominee
-To be filled by the nominating Association and signed/accept email by the nominee
-Completed application forms should be submitted on or before the 15th of August 2017
Email Address (Nominee)
Confirmation mails will be sent to this email address
Your answer
Name of the Nominee
(Rev/Prof/Dr/Mr/Miss/Mrs)
Your answer
Designation/Profession
Your answer
Organization/Employer
Your answer
Date of Birth
MM
/
DD
/
YYYY
Tel.
(Land line)
Your answer
Mobile No.
Your answer
Address Line 1
Your answer
Address Line 2
Your answer
City
Your answer
Provice
Your answer
Country
Required
Memberships of any Professional Associations
Your answer
Type of forwarding Association:
ICT Association/Trade Association/Professional Association
Your answer
Name of the Association:
Your answer
Contact Person’s Name:
Your answer
Mobile No:
Your answer
Telephone No:
Your answer
e-mail Address:
Your answer
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