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2011 WEC Gold Medal Award Nomination Form

This Form must be submitted by August 20, 2010. After the Jury reviews this initial application, eligible candidates will be notified and invited to make full submissions by October 29, 2010.

2011 WEC GOLD MEDAL FOR INTERNATIONAL CORPORATE
ACHIEVEMENT IN SUSTAINABLE DEVELOPMENT

Note: All fields are required

Name of Nominee Company:
Address:
Is Nominee a Parent Company or Subsidiary?
Number of Employees:
Sales (in US$):
Annual Report URL:
Environmental / Social Responsibility Report URL:
Social Responsibility Report URL:

Briefly describe the environmental and sustainable development policies and practices that illustrate the Nominee's qualifications for the WEC Gold Medal:
List countries where the Nominee Company has manufacturing/processing facilities:


Signature / Name of Nominator of Nominator (please type your full name):

Name of Nominator:

Title:

Affiliation:

Address:

Phone: (please include country/area code)

Fax: (please include country/area code)

E-mail: