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Antarctic Division
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Phillip Law Medal - Nomination Form

Nomination Form for the Phillip Law Medal


The Phillip Law Medal
Nomination of Candidate


Name of Nominee: .................................................................................

Current role /post of nominee:.......................................................................................................................................................

Address: ...............................................................................

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Postcode: .........  Country: ............................................. 

Email address: .................................................................................


Phone numbers: .................................................................................
 
Name of individual or organisation making this nomination:

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Briefly describe (500 words or less) the role which the nominee plays/ has played in Antarctic affairs and the Antarctic community.

  
 

 

 

 

 

Briefly describe (500 words or less) why you believe the nominee would be a suitable recipient of the PG Law Medal.


 

 

 

 

 

Name and contact details of a person who may be contacted in relation to this nomination.

Name: .................................................................................
Address: .................................................................................

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Email address: .................................................................................

Phone numbers: .................................................................................


Please attach the names and contact details of three individuals  who are familiar with the work of the nominee, who would be willing and available to be contacted by the Club to provide comment on the suitability of the nominee to be the recipient of the Medal.  

Please attach any other supporting documentation, such as biographical details or links or references to the nominee's work.