POTATO INDUSTRY AWARD SCHEME 2014 NOMINATION FORM

THE BRITISH POTATO INDUSTRY AWARD SCHEME 2014 NOMINATION FORM
A. PROPOSER
NAME*

First NameLast Name
Professional Status*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Fax Number

Area CodePhone Number
E-mail*
B. NOMINEE
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Fax Number

Area CodePhone Number
E-mail*
C. CAREER SYNOPSIS OF NOMINEE
Synopsis*
D. REASONS FOR NOMINATION FOR AWARD (Max 250 words)
Reasons*

0/250
Should be Empty: