2015 PACE ZENITH AWARDS ENTRY FORM: LIFETIME ACHIEVEMENT Please complete the following form to nominate a person for the Lifetime Achievement Award. This award will be presented to a person who has worked in process control or automation for a minimum of 25 years, and in a senior position, supervisory or technical leadership role for a minimum of 10 years. Judges will award marks based on: o added value to the company o added value to the process control/automation community o demonstrated innovation o quality of results o completed projects o demonstration of initiative Person Nominated: (Please write the exact name to be used on certificates, trophies and in promotional material – limit to 50 characters including spaces) Position Title: Company: Suburb: City: State & Postcode: Employment History Job Title | Company | Period: Job Title | Company | Period: Job Title | Company | Period: Job Title | Company | Period: Job Title | Company | Period: Job Title | Company | Period: Nominee’s Birth Date: (mm/yyyy) 1 Nominated by: Name: Phone/Mobile: Email: Contact address: Please supply a brief overview of the business (location, market, products, size). (Suggested maximum 400 words) Please supply a brief overview of the person’s key job function and responsibilities. (Suggested maximum 300 words) Please describe how the person has added value to the business (demonstrated innovation and creativity, delivered results, completed projects, made savings, added to the bottom line, benefited the engineering community). (Suggested maximum 300 words) 2 Please outline outstanding achievements the person has achieved in the wider process control and automation community. (Suggested maximum 300 words) Please attach a high resolution photograph of the person being nominated. ___________________________________________________________________________ ___ MAILING DETAILS Nominations can be submitted via email to PACE at awards@pacetoday.com.au Hard copy material to support your nomination may be sent to PACE Editor Kevin Gomez: Mail: Courier: PACE Zenith Awards Attn: Kevin Gomez Locked Bag 2999 Chatswood DC NSW 2067 Kevin Gomez PACE Zenith Awards Cirrus Media Tower 2, Level 3 475 Victoria Avenue Chatswood, NSW 2067 Checklist Have you included Colour photographs of person being nominated (high-resolution, minimum 300 dpi) We look forward to receiving your entry! Important Information: Please note that your contact details may be disclosed on a limited basis to sponsors to promote information relevant to your business. You have the opportunity to opt-out of these communications at any time. Please tick here to opt-out. 3