ACEM Distinguished Service Award nomination

ACEM Distinguished Service Award nomination
Form No: AP644
Last Revised: February 2025
Version: v4
Nominee
We, the undersigned, nominate the individual named below for the consideration of * for the award of the ACEM Distinguished Service Award (the Award).
Nominee name*

First NameLast Name
We have read the ACEM Distinguished Service Award Policy (AP594) 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
Proposer name*

First NameLast Name
Proposer email*
example@example.com
Proposer signature*

Clear
Date*

DayMonthYear
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:*

Board memberFACEM member of CAPPFACEM member of COEOther (please specify)
Seconder details

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

First NameLast Name
Seconder email*
example@example.com
Citation
A citation in support of the nomination (not exceeding 400 words) must accompany the nomination. Please provide the citation below.*

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 5 May 2025.

Seconder
Seconder name

First NameLast Name
Seconder signature

Clear
Date

DayMonthYear
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:

Board memberFACEM member of CAPPFACEM member of COEOther (please specify)
Submission
This Nomination Form, including the citation in support of the nomination, must be submitted by no later than 5pm (AEST) on Monday 5 May 2025.
Should be Empty:

Nominee