IHA Entry Form

Independent Healthcare Awards

Please submit your nomination for the Independent Healthcare Awards 2012 using the form below. The closing date is Monday 16 April 2012.

Tel. 020 7923 5392 or
Email awards@laingbuisson.co.uk

Independent Healthcare Awards Entry Form

Please complete all the fields on this form to submit your entry.

The deadline for submitting nominations is Monday 16 April 2012.

Choose a Category of award for which you wish to nominate yourself, a colleague or a team. Mandatory fields are marked *

Categories:*

Nominee:

Enter the name of nominated team or individual:*

Nominee Job Title:*

Organisation:*

Address:*

Postal Code:*

Telephone:*

Email Address:*

Nominator - Your Details:

Name:*

Job Title:*

Telephone:*

Email:*

Please summarise why your entry should be considered as a finalist in this category.

maximum 400 words:*

View the criteria for the categories.
Please note that we cannot accept any additional supporting evidence. If you wish to make another entry for another category, you must fill in a separate entry form for each category of award. You will be given the opportunity to do this after submitting this form.

Submit IHA Nomination Entry