Professional 100 Nomination Form

Professional 100

Hospital Professional News will consider self-nomination and nomination by another person or organisation. If nominating an individual, please complete section A, B and C. If self-nominating please complete section A and C.

Please note, the deadline for applications is the 4th of October 2021

A. Entrant/Nominee Information

Full Name*

First NameLast Name

Prefix:*

Job Title:*

Organisation*

Email:*

Phone Number*

Area CodePhone Number

B. Nominator Information

Full name

Prefix

Job title

Organisation

Email

Phone Number

Area CodePhone Number

Do you wish to remain anonymous to your nominee?

YesNo

Has the nominee consented to appearing in the Professional 100 listing?

YesNo

C. Entry Requirements

To enter, please provide a bio (150-200 words) outlining any research or career highlights from the past 12 months and a high resolution photo of the nominee/self.*

D. Additional Information (optional)

Please add any additional information (800 words maximum) to support your nomination

If you have any quetions, please contact Carla Fulton: editorial@hospitalprofessionalnews.ie

0872907793