Nominations for the David Bromham Memorial Award

Please complete all details on this form. It will be automatically forwarded to the relevant staff member. 

Nominations close annually on the 7th April and submissions are considered by the committee when it meets in May or June each year. Following the committee's decision, you can expect to hear back from us by the end of June annually.

If you would like a copy of your responses (which can be useful, should you apply for other things in the future), please add your email address in the relevant field at the bottom of this form.

The information you have shared on this form will be used by the relevant FSRH Committee and FSRH staff for the purposes of administration only. FSRH will keep this information securely on our systems. Our full privacy policy can be viewed here.

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Full details of Nominator

Please fill in your full contact details so that we can get in touch with you after the submission has been considered by the relevant committee at FSRH.

We also ask you to submit a short citation to support your nomination. The citation should be a maximum of 500 words.

Nominee Details

Please give us as many personal details of the person you are nominating as possible. Thank you.

Citation to Support Nomination

Please submit a citation to support your nomination (no more than 500 words max)

Guidance on your citation

The Award is not intended to be a prize for a long and distinguished service, rather for a piece of work which through inspiration, innovation or energy has furthered the practice of sexual and reproductive healthcare in any way and any setting. It is not a research grant. Younger health professionals sometimes undervalue their achievements but they are exactly the people that David Bromham would have wished to see encouraged as this award now acknowledges.

Nominations

The award will be made either to an individual (who must be a current member of the Faculty), or to a team, which could be multi-disciplinary. In the latter case the lead doctor should be a current member of the Faculty. You may nominate yourself or your team or be nominated by someone else. 

How to submit your citation (two options)

1. Citations can by typed into the box below. Or you can copy and paste the text into the text box.

2. If you prefer, you can upload your citation by clicking on 'choose file' then browsing on your computer to select the relevant file for upload

 

Verification

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