National Awards Entry Form National Awards Entry Form

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National Awards Entry Form National Awards Entry Form Powered By Docstoc
					                   National Awards Entry Form
                                                          Entrant Details
  All entrants agree to the use of their image/information by Alzheimers New Zealand and their strategic partners for the purpose of publicity

Name

Organisation

Address

Phone (day)                                   Email



                                                           Award Details
                                              Category (tick as many as apply)

        Outstanding Contribution in the field of Dementia                                     Team of the Year

                                          Unsung Hero of the Year                             Volunteer of the Year

Please describe your contribution (attach another sheet of paper if you need more space)




                    All entries must be received no later than 5pm, Thursday 1 st April 2010

All completed entry forms will be judged by a panel elected by Alzheimers New Zealand National Office.
Judges decisions are final.

Send Entries to:           Alzheimers New Zealand, PO Box 3643, Wellington 6140
                           Level 3, Adelphi Finance House, 15 Courtenay Place, Wellington
                           Email: nationaloffice@alzheimers.org.nz or call for enquiries 04 381 2362