Date

Title* --Select-- Mr. Mrs. Ms. Prof. Dr.

Nominee's First Name*

Nominee's Last Name*

E-mail Address *

Phone

Nominee's Address

City

Country --Select-- AfghanistanAfricaAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustralia and New ZealandAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)Congo, Democratic Republic ofCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicCzech Republic and SlovakiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth AfricaNorth KoreaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaScotlandSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaTürkiyeThailandTogoTongaTrinidad and TobagoTunisiaTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUSAUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaYemenYugoslavia (Serbia and Montenegro)ZambiaZimbabwe

Nominator's First Name

Nominator's Last Name

Phone

E-mail Address

Country --Select-- AfghanistanAfricaAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustralia and New ZealandAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)Congo, Democratic Republic ofCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicCzech Republic and SlovakiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth AfricaNorth KoreaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaScotlandSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaTürkiyeThailandTogoTongaTrinidad and TobagoTunisiaTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUSAUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaYemenYugoslavia (Serbia and Montenegro)ZambiaZimbabwe

1) The nominee has been actively involved in expanding packaging knowledge, supporting packaging education, and furthering an understanding of contributions that packaging makes to society in the following manner:

2) The nominee has contributed to the technical, marketing, and/or economic advancement of the field of packaging in the following manner:

3) Other packaging community-related achievements include:

4) The nominee has demonstrated leadership within the organisation for which he/she has worked, the communities in which he/she has lived and in the packaging business in general in the following manner:

5) Other business achievements:

6) Other personal and community achievements regarding the nominee:

A head and shoulders image of the candidate, jpeg format, maximum file size 2MB.