Award Nomination Form for P23 Labs Women in Science Wednesdays
Please fill the form below accurately and ensure you indicate nominee name and reason for nomination.
Nominated Person
*
Company
Position
E-mail
example@example.com
Phone Number
Please share any social media handles of individual and/or affiliated company.
Nominator:
Person submitting the nomination
Full Name
*
First Name
Last Name
Company
Position
E-mail
*
example@example.com
Phone Number
*
Nominee Information
Please indicate details about your nomination. Indicate which P23 Labs core value, this nominee represents. You may select as many as applicable.
Categories:
*
Be Giving
Be Excellent
Be Reliable
Be Accountable
Be Trusted
Other
Describe in a few words the reason this woman was chosen and how she has transformed/inspired you and/or the scientific community.
*
Submit
Should be Empty: