AusACPDM Lifetime Membership Nomination

Do you know someone who has made a significant contribution to the AusACPDM? Nominate them for lifetime membership!

Lifetime memberships of the Academy recognise individuals who have made a considerable and extensive contribution to the development of the AusACPDM and/or recognise a special accomplishment, contribution or pre-eminence in the fields of cerebral palsy, neurodevelopmental disabilities and developmental disorders.

Nominations are reviewed by the Board of Directors, and successful nominations are awarded at the next Scientific Conference.

If you would like to nominate someone for lifetime membership please complete the following form:

    Your Name*

    Your Role*

    Your Place of Work*

    Best Contact Email*

    Name of the Person You Are Nominating*

    Role(s) of the Person You Are Nominating*

    Their Place of Work*

    Please give some details to support your nomination

    Give example(s) of how this person has made considerable and extensive contribution to the development of the AusACPDM*

    Give example(s) of any special accomplishments, contributions or how this person is pre-eminent in the fields of cerebral palsy, neurodevelopmental disabilities and developmental disorders*

    Are there any other factors we should consider?*

    Would you like to be sent a copy of this nomination (need to ensure email above)*

    yesno

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