Silver Medal

Nomination Form

• Download the nomination form (148KB)

• Download the nomination form (1028KB)

or complete the form below and submit

(*) Indicates required fields

	1. Information on nominee
	Full name*
	Date of birth*
	No. of years in full time employment or equivalent on 1 January 2008*
	Address*
	Tel*
	Fax
	E-mail*
	Appointment*
	Academic qualifications*
	Professional qualifications* giving Institution and grade of membership
	Is Nominee a chartered engineer (CEng)?	Yes No
	2. Brief citation* (not more than 30 carefully edited words which convey the nominee's outstanding personal contribution):
	3. Information on Nominator
	Name*
	Address*
	Tel
	Fax
	E-mail*
	Extent or personal knowledge of nominee*
	4. Citation* describing outstanding and demonstrated personal contribution of nominee to British engineering resulting in successful market exploitation (see note 8b) (in not more than 500 words):
	5. Describe the technical achievements of nominee* (see note 8c) (in not more than 250 words):
	6. Outline the commercial success of nominee* (see note 8d) (in not more than 250 words):
	Date*
	Signed*
	Before you can submit your request, we need to make sure it is not an automated computer program that's submitting the form. To achieve this, please enter the two words displayed below in the textbox, separated by a space.

Please click only ONCE and wait for the form to be submitted.

Please send the form to:

Alexandra Pennington
Assistant Manager, Awards & Events

[E-mail Alex]

Tel: 020 7766 0685
Fax: 020 7930 1549

Please ensure that the nominee’s curriculum vitae follows within 2 days of submitting the nomination form. The information can be sent by post or email.

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Silver Medal Nomination form Rules and conditions Winners 2000 - 2004 Winners 1995 - 1999