Please note, nominators and nominees must both be BVA members.

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* 1. Name of nominee

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* 2. Relevant qualifications of nominee

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* 3. Supporting statement summarising why the nominee is deserving of the award (maximum of 200 words).

 
Data supporting the next three categories should reflect significant contributions

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* 4. Country/countries in which the nominee has worked or is working

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* 5. Significant contributions overseas such as animal health, animal welfare, public health, environmental needs, communities

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* 6. Services to the veterinary profession such as to BVA and RCVS, and elsewhere, for example educational, advisory, supportive

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* 7. Name of nominator

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* 8. Email address of nominator

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