AUSTRALIAN MEN’S HEALTH FORUM PO BOX 741 RICHMOND NSW 2753 T 0414 950 902 E
[email protected] ABN: 31 209 049 926
2018 AMHF Men’s Health Awards Nomination Form
The 2018 AMHF Men’s Health Awards will be presented at National Men’s Health Gathering Dinner on Tuesday 13 November 2018 at the Novotel Parramatta, NSW. These prestigious Awards will honour those who have made an outstanding contribution to the men's health field. Closing date: Nominations are to be made to
[email protected] and close on Monday 1st October 2018. The awards categories are: 1. Significant contribution made by an individual to improve men’s health and wellbeing 2. Significant contribution made by a group or organisation to improve men’s health and wellbeing 3. Significant contribution made by an individual to improve Aboriginal & Torres Strait Islander male health and wellbeing 4. Significant contribution made by a group or organisation to improve Aboriginal & Torres Strait Islander male health and wellbeing 5. Significant contribution to improving the health and wellbeing of young men and boys 6. Significant contribution to designing, developing or delivering male-friendly services
AMHF.ORG.AU
THE PEAK BODY FOR MEN’S HEALTH
AUSTRALIAN MEN’S HEALTH FORUM PO BOX 741 RICHMOND NSW 2753 T 0414 950 902 E
[email protected] ABN: 31 209 049 926
1. Who is nominating this person? Name of nominator Position Organisation Phone Email
2. Who is being nominated? Name of person nominated Position Organisation Postal Address Phone Email
3. Please highlight or mark the category in which you are nominating. Significant contribution made by an individual to improve men’s health and wellbeing Significant contribution made by a group or organisation to improve men’s health and wellbeing Significant Contribution made by an individual to improve Aboriginal & Torres Strait Islander male health and wellbeing Significant Contribution made by a group or organisation to improve Aboriginal & Torres Strait Islander male health and wellbeing Significant Contribution to improving the health and wellbeing of young men and boys Significant Contribution to designing, developing or delivering male-friendly services
AMHF.ORG.AU
THE PEAK BODY FOR MEN’S HEALTH
AUSTRALIAN MEN’S HEALTH FORUM PO BOX 741 RICHMOND NSW 2753 T 0414 950 902 E
[email protected] ABN: 31 209 049 926
4. Please describe the achievements of the person or group that you are nominating (max. 1000 words) You might like to include: • A description of the work this person or group has undertaken in the men’s health and wellbeing area including projects, programs, policy or research areas • Information on community needs this person’s work has addressed (Max. 1000 words)
AMHF.ORG.AU
THE PEAK BODY FOR MEN’S HEALTH
AUSTRALIAN MEN’S HEALTH FORUM PO BOX 741 RICHMOND NSW 2753 T 0414 950 902 E
[email protected] ABN: 31 209 049 926
Disclaimer The AMHF Awards 2018 are judged solely on the content provided to AMHF with each nomination and with minimal additional checking performed by the AMHF Judging Panel. AMHF relies on the information provided by the nominees and their declaration as to its accuracy and completeness and the inclusion of nominees in the list of nominees and the issue of an Award or commendation to a recipient is not an endorsement or recommendation by AMHF of the Award recipient's products or services. The decision of the Judging Panel will be final and will be solely based on information provided in this nomination form. No correspondence will be entered into in respect to the Judging Panel’s final decisions. 5. Declaration by Nominator I declare that: 1. All the information submitted in this nomination form is true and accurate in all material respects and is not misleading or incomplete in any material way. 2. There are no facts or circumstances which would, if disclosed, disqualify the nominee or, if any Award or commendation is made to the nominee, would result in that Award of commendation being withdrawn. 3. There are no facts or circumstances relating to the nominee which may, if any Award or commendation is made to the nominee, harm the reputation of AMHF. Signature ________________________________ Name: __________________________________ Date: ____________________________________
AMHF.ORG.AU
THE PEAK BODY FOR MEN’S HEALTH
