{"id":1130,"date":"2021-06-23T20:30:38","date_gmt":"2021-06-23T20:30:38","guid":{"rendered":"https:\/\/www.impactafricasummit.org\/?page_id=1130"},"modified":"2023-03-15T13:41:28","modified_gmt":"2023-03-15T13:41:28","slug":"category-11-nomination-form","status":"publish","type":"page","link":"https:\/\/www.impactafricasummit.org\/pias\/category-11-nomination-form\/","title":{"rendered":"Category 11 Nomination Form"},"content":{"rendered":"<h2>Lifetime Achievement Excellence Awards 2023<\/h2>\n<p>This Award recognizes consistent history of service, above and beyond the call of duty, throughout a distinguished career in Research and\u202fDevelopment\u202for clinical research\u202fin Africa; with nominees being retired or semi-retired but still active in\u202fAfrican\u202fresearch in some capacity<\/p>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1092-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/pias\/wp-json\/wp\/v2\/pages\/1130#wpcf7-f1092-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1092\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.2\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1092-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p>&nbsp;\n<\/p>\n<h7>Nomination Form:\n<\/h7>\n<p>Fill in your personal details below\n<\/p>\n<div class=\"halfbox\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"sendersname\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your Name:\" value=\"\" type=\"text\" name=\"sendersname\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"halfbox\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"senderscountry\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your Country:\" value=\"\" type=\"text\" name=\"senderscountry\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"halfbox\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"sendersphone\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Phone Number:\" value=\"\" type=\"tel\" name=\"sendersphone\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"halfbox\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"sendersemail\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Email Address:\" value=\"\" type=\"email\" name=\"sendersemail\" \/><\/span>\n\t<\/p>\n<\/div>\n<p>Fill in the Nominee's details below:\n<\/p>\n<div class=\"halfbox\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nomineesname\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Nominee&#039;s Name:\" value=\"\" type=\"text\" name=\"nomineesname\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"halfbox\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nominationsubcategory\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"nominationsubcategory\"><option value=\"Nomination Sub-category:\">Nomination Sub-category:<\/option><option value=\"Sub-category 01: Healthcare Alliance and Partnership Excellence Awards (Patient Advocacy Group)\">Sub-category 01: Healthcare Alliance and Partnership Excellence Awards (Patient Advocacy Group)<\/option><option value=\"Sub-category 02: Healthcare Alliance and Partnership Excellence Awards (Nonprofits)\">Sub-category 02: Healthcare Alliance and Partnership Excellence Awards (Nonprofits)<\/option><option value=\"Sub-category 03: Healthcare Alliance and Partnership Excellence Awards (Corporate)\">Sub-category 03: Healthcare Alliance and Partnership Excellence Awards (Corporate)<\/option><\/select><\/span>\n\t<\/p>\n<\/div>\n<div class=\"halfbox\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nomineescountry\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Nominee&#039;s Country:\" value=\"\" type=\"text\" name=\"nomineescountry\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"halfbox\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nomineesphone\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Nominee&#039;s Phone Number:\" value=\"\" type=\"tel\" name=\"nomineesphone\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"halfbox\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nomineesemail\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Nominee&#039;s Email Address:\" value=\"\" type=\"email\" name=\"nomineesemail\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"halfbox\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"reasonfornomination\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Reason for Nomination:\" value=\"\" type=\"text\" name=\"reasonfornomination\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"halfbox\">\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>Lifetime Achievement Excellence Awards 2023 This Award recognizes consistent history of service, above and beyond the call of duty, throughout a distinguished career in Research and\u202fDevelopment\u202for clinical research\u202fin Africa; with nominees being retired or semi-retired but still active in\u202fAfrican\u202fresearch in some capacity<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1130","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.impactafricasummit.org\/pias\/wp-json\/wp\/v2\/pages\/1130","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.impactafricasummit.org\/pias\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.impactafricasummit.org\/pias\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.impactafricasummit.org\/pias\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.impactafricasummit.org\/pias\/wp-json\/wp\/v2\/comments?post=1130"}],"version-history":[{"count":5,"href":"https:\/\/www.impactafricasummit.org\/pias\/wp-json\/wp\/v2\/pages\/1130\/revisions"}],"predecessor-version":[{"id":4288,"href":"https:\/\/www.impactafricasummit.org\/pias\/wp-json\/wp\/v2\/pages\/1130\/revisions\/4288"}],"wp:attachment":[{"href":"https:\/\/www.impactafricasummit.org\/pias\/wp-json\/wp\/v2\/media?parent=1130"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}