Fonterra dairy woman of the year Nominee form

Please note: The below form is an online form and cannot be saved once you have started completing the questions.

Click here to download the nominee form

NOMINEE DETAILS

Nominee Name *

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

NOMINEE QUESTIONS

What is your connection and involvement with the dairy sector? *

How are you actively working towards adding value to the dairy sector? *

What are you most passionate about in the dairy sector and how do you see yourself influencing change? *

Do you see yourself as a positive role model for your peers and beyond? Please provide examples *

Why would receiving this award be important to you? *

Please upload a head and shoulders image of yourself. Image size of 1MB minimum. *

Click or drag a file to this area to upload.

Acknowledgement *

By ticking this box, you agree to the below Acknowledgement Statement.

1. I, [nominee name], warrant that I have never acted or behaved in a manner and will not during the period of the FDW Award (as defined below) act or behave in a manner which, in the reasonable opinion of Dairy Women’s Network (DWN), is likely to detract from the reputation of DWN or any sponsors of the Fonterra Dairy Woman of the Year award (FDW Award), and/or causes or is likely to cause DWN or any sponsors of the FDW Award to be brought into disrepute, contempt, scandal or ridicule, or otherwise cause or likely to cause public controversy or adversely affect the reputation of DWN or any sponsors of the FDW Award or the value of the sponsorship relating to the FDW Award to DWN.

2. I acknowledge that if I am the winner of the FDW Award, any sponsorship benefits received or associated with the FDW Award may be revoked or cancelled if DWN finds evidence that I have failed to act in accordance with clause 1 above.

Fonterra dairy woman of the year Nominee form

NOMINEE DETAILS

NOMINEE QUESTIONS

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