ACHIEVER OF THE YEAR AWARD The Insurance Institute of Cheltenham & Gloucester Achiever of the Year Award Entry Form 2016 – Name of Candidate Name of Sponsor Business Address of Candidate Contact No E-mail Business Address of Sponsor if different – Contact No (if different) – E-mail Reasons for Nomination Career: Professional Study: Local Institute Involvement: Charity Events: Summary: Signature of Candidate Signature of Sponsor Please return the completed form by 11th March 2016 Insurance to: Tracey O’Neill, Pro Global Solutions, Southgate House, Southgate Street, Gloucester, GL1 1UB e-mail: tracey.oneill@pro-global.com
ACHIEVER OF THE YEAR AWARD The Insurance Institute of Cheltenham & Gloucester Achiever of the Year Award – Entry Form 2016 Name of Candidate Name of Sponsor Business Address of Candidate Contact No E-mail Business Address of Sponsor – if different Contact No – (if different) E-mail Reasons for Nomination Career: Professional Study: Local Institute Involvement: Charity Events: Summary: Signature of Candidate Signature of Sponsor Please return the completed form by 11th March 2016 to: Tracey O’Neill, Pro Global Insurance Solutions, Southgate House, Southgate Street, Gloucester, GL1 1UB e-mail: tracey.oneill@pro-global.com
achiever-of-the-year-nomination-form-2016.docx