ISPO World Congress 2021 – Brian & Joyce Blatchford Award Application Form

ISPO World Congress 2021 – Brian &Joyce Blatchford Award Application Form
The ISPO Scientific Committee kindly invites its Member Societies and members to apply for the 2021 Brian & Joyce Blatchford Award which will be presented at the next ISPO World Congress that takes place virtually from 1-4 November 2021.

Established by the Blatchford Family to honour the memory of Brian & Joyce Blatchford, the prize is awarded to a team that has an outstanding record of innovative achievement in the field of prosthetics and/or orthotics. The achievement should be related to prosthetic and/or orthotic hardware, or scientifically based new techniques which result in better prostheses or orthoses.

This Application Form should be completed by 31 August 2021. Persons involved or associated with ISPO Scientific Committee or judging panel for the Brian & Joyce Blatchford Award cannot apply for this award.

Information of the team Members

Team Member 1
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Title*
Nationality *
Country of Work *
Education*
Professional Experience*
Skills and Expertise*
Experience in Working in Organizations at National Level*
Experience in Working in Organizations at International Level*
Do you need to add a team member 2 ?*

YesNo

Team Member 2
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Nationality *
Title*
Country of Work *
Education*
Professional Experience*
Skills and Expertise*
Experience in Working in Organizations at National Level*
Experience in Working in Organizations at International Level*
Do you need to add a team member 3 ?*

YesNo

Team Member 3
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Nationality *
Title*
Country of Work *
Education*
Professional Experience*
Skills and Expertise*
Experience in Working in Organizations at National Level*
Experience in Working in Organizations at International Level*
Do you need to add a team member 4 ?*

YesNo

Team member 4
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Nationality *
Title*
Country of Work *
Education*
Professional Experience*
Skills and Expertise*
Experience in Working in Organizations at National Level*
Experience in Working in Organizations at International Level*
Do you need to add a team member 5 ?*

YesNo

Team member 5
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Title*
Nationality *
Country of Work *
Education*
Professional Experience*
Skills and Expertise*
Experience in Working in Organizations at National Level*
Experience in Working in Organizations at International Level*

Justifications
Please give full track record of evidences according to the selection criteria?*
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