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Propose a candidate for the R. Geigy Award

* = Mandatory fields

Information about the candidate

Title*:

Mrs.

Mr.

Degree:

Name*:

First name*:

Position*:

Employer*:

Street*:

ZIP/City*:

Country*:

Phone*:

E-Mail*:

Briefly describe your reason for nominating this person:*

Nomination put forward by:

Title*:

Mrs.

Mr.

Degree:

Name*:

First name*:

Position*:

Employer*:

Street*:

ZIP/City*:

Country*:

Phone*:

E-Mail*:

Enclosures

(only PDF, WORD/Excel, ZIP-files with max. 50 MB allowed)

Cover letter*:

Detailed description of the reasons for nominating this candidate for the R. Geigy Award*:

Candidate's curriculum vitae*:

List of the candidate's publications:

R. Geigy Foundation
Socinstrasse 57, CH-4002 Basel
mail@geigystiftung.ch

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