NOMINATE

Limpopo Medical Awards 2026 Official Nomination Form

Honouring Legacy. Inspiring Excellence. Advancing Healthcare.

SECTION 1: NOMINATOR DETAILS

Full name

Phone (WhatsApp preferred)

Relationship to nominee

SECTION 2: NOMINEE DETAILS

Nominee full name

Profession/ Role

Organisation/ Practice name

Work Location

Contact Details of Nominee

SECTION 3: AWARD CATEGORY

Select One Award Category

SECTION 4: MOTIVATION FOR NOMINATION

Why are you nominating this individual?

Describe the nominee’s impact in healthcare.

Provide specific examples of achievements or contributions

⁠How has the nominee demonstrated excellence or leadership?

SECTION 5: SUPPORTING INFORMATION

Upload Supporting Documents (optional)

(CV, certificates, media articles, testimonials, etc.)

SECTION 6: DECLARATION

I confirm that the information provided is accurate and that I have permission to nominate this individual.

SECTION 7: CONSENT

Consent for Use of Information