Safety Solution of the Year Nomination Form

All fields marked with * must be completed

YOUR DETAILS

Name:*

Email:*


NOMINEE DETAILS

Company:*

Contact name:*

Position title:

Street address:*

Suburb:*

State:*

Postcode:*

Phone:*

Email:*


Please write a brief overview of the business:*
Suggested maximum 200 words

Please explain the safety issue your organisation is trying to address:*
Suggested maximum 300 words

Please explain your safety development/technology/initiative:*
Suggested maximum 300 words

Please explain how your development/technology/initiative is successfully addressing the safety issue:*
Suggested maximum 300 words

You may attach up to three (3) supplementary files (photographs, diagrams, maps, etc.):
Combined file size must not exceed 10MB
1.
2.
3.

How did you hear about the Endeavour Awards?
 Manufacturers' Monthly magazine

 www.manmonthly.com.au

 Word of mouth
 Other (please specify)


TERMS & CONDITIONS

1. By submitting a nomination, you give permission for Manufacturers' Monthly to publish information about your company and project.
2. You also consent to Manufacturers' Monthly and parent company Prime Creative Media collecting your information, and to receiving information on other events and publications. Your contact information will not be disclosed to any third parties.
3. If nominating on behalf of another company or person, Manufacturers' Monthly and Prime Creative Media relies that you have authority to act on behalf of this company or person to submit their information and consent to the terms & conditions on their behalf.
 Yes, I accept the terms & conditions