Nomination Form: Dame Tariana Turia Award 2027

Details of Nominator:

First Name *

Last Name *

Contact phone number

Email Address *

What is your connection to the nominee? *

Details of Nominee

First Name *

Last Name *

Contact phone number

Email Address *

Ethnicity of Nominee: *

Please note: This form is only part-one of the two-part nomination process.

Once you have completed this form, please gather your evidence and letters of endorsement to support your nomination and upload it through the portal on our World Smokefree May website.

I understand, my nomination is not complete until I have uploaded the supporting documents. *