European Smokefree Supporter 2008 Application Form

This award is for people to nominate a health professional to become the European Smokefree Supporter 2008 in recognition of their work in helping smokers to stop. QUIT are looking for a health professional or team who has gone that extra mile to help people quit smoking.

Prizes

The winners from each participating country will be presented with a prestigious award and the overall European winner will be invited to the award ceremony in Amsterdam in September 2008.

Deadline Dates

Deadline for entries is June 30th 2008.


SECTION 1

YOUR CONTACT DETAILS
Title / First Name / Surname  
Address  
Post Code  
Email Address  
Daytime Telephone  
How do you know the person you are nominating?
(i.e. patient/friend/colleague)  

PLEASE SUPPLY THE CONTACT DETAILS OF THE PERSON/TEAM (MAIN CONTACT) YOU ARE NOMINATING
Title / First Name / Surname  
Work Address  
Post Code  
Email Address  
Daytime Telephone  
Job Title  
How did you hear about 
European Smokefree Supporter 
of the Year 2008?  		National newspaper*
  Local newspaper *
  Radio *
  Television *
  Poster *
  Health Professional *
  Globalink
  * Please give details
 
  other (please state below:)
 

SECTION 2

IMPORTANT INFORMATION
In order to qualify for the European Smokefree Supporter of the Year 2008 the nominee/s must be working within the UK. QUIT will contact you and the nominee/s if the nominee/s reaches the finals. Nominee/s must be happy to take part in publicity. Entry implies acceptance of these rules.
 

1. In no more than 500 words, why do you think they deserve to be nominated European Smokefree Supporter of the Year 2008?

The selection panel will be looking for examples of professionalism, innovation and dedication that make this individual or team stand out. 
 
SECTION 3

The details of the nominating individual will be passed on to Pfizer who would like to contact you with details of their range of NRT products. Should you not wish to receive any information from them please tick The details will not be used for any other purpose.

I do NOT wish to receive any unsolicited information, material, or publication updates from QUIT.

To my knowledge all information supplied here is correct and I agree to comply with the rules of the competition laid out below. 



RULES OF ENTRY
The deadline for entries is June 30th 2008. Nominees must be aged 16 or over and a UK resident. No liability will be accepted for lost, damaged or delayed entries. Proof of posting cannot be accepted as proof of delivery. No cash prize available. Final choice of the awards is at the Selection Panel's discretion. The Selection Panel’s decision is final. No correspondence will be entered into. Entrants must be prepared to co-operate in any media coverage. The contest is not open to employees and families of QUIT, Pfizer, or anyone connected with the organisation of the competition.
Entry implies acceptance of these rules.  

Details of winners will be available in Autumn 2008. Thank you for your interest in the European Smokefree Supporter of the Year Award 2008.