ACEM Distinguished Service Award nomination

  • ACEM Distinguished Service Award nomination

  • Form No: F644
    Last Revised: March 2026
    Version: v5

  • Nominee

  • We, the undersigned, nominate the individual named below for the consideration of   *   for the award of the ACEM Distinguished Service Award (the Award).

  • We have read the ACEM Distinguished Service Award Policy P594 (V4.1) associated with the Award and are of the view that the nominee meets the requirements for consideration of the Award. As required, a citation in support of the nomination accompanies this Nomination Form.

    We declare that we meet the criteria described in the policy to enable this nomination to be made and are aware that the nomination will ordinarily be considered in the first instance by either CAPP or COE, as applicable, with a majority vote in support of the nomination required to enable the nomination to be forwarded to the ACEM Board for consideration.

  • Nominators

    • Proposer 
    • Date*
       - -
    • Please tick as appropriate. At least one of the proposer and the other nominator must be a FACEM member of the Council to which the nomination is being made, or where a nomination is being made direct to the ACEM Board, at least one of the two must be a member of the ACEM Board. I am a:*

    • Seconder details

      These details will be used to notify your seconder to complete their section of this form

    • Citation

    • 0/400

    • Submission

    • This Nomination Form, including the citation in support of the nomination, must be submitted by no later than 5pm (AEST) on Monday 11 May 2026.

    • Seconder 
    • Date
       - -
    • Please tick as appropriate. At least one of the proposer and the other nominator must be a FACEM member of the Council to which the nomination is being made, or where a nomination is being made direct to the ACEM Board, at least one of the two must be a member of the ACEM Board. I am a:

    • Submission

    • This Nomination Form, including the citation in support of the nomination, must be submitted by no later than 5pm (AEST) on Monday 11 May 2026.

    • Should be Empty: