VARIAN AWARD 2012
NOMINATION FORM
You may nominate yourself or any other member of the AIR. Simply forward the nomination form to the
Secretary of the Radiation Therapy Advisory Panel (RTAP) at Anthony.Arnold@sesiahs.health.nsw.gov.au.
Nominations for the 2012 Varian Award close Friday 2nd November 2012
AIR CONTRIBUTIONS
 Have you been an AIR member for 5 years or more?
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 Please describe all roles you have undertaken for the AIR
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 Please describe your significant achievements in these roles
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OTHER PROFESSIONAL SOCIETIES / REGULATORY AGENCIES / BODIES ETC.
 Are you involved with other professional societies or regulatory agencies/bodies etc?
Please describe your involvement and significant achievements
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PRESENTATIONS AND PUBLICATIONS
 Please list your papers, posters and publications (including book chapters) for the past 10 years
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CONTRIBUTIONS TO RADIATION THERAPY PROFESSION
 Please describe your significant contributions to the Radiation Therapy profession
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Thank you for your nomination.